CEN10LA005

NTSB accident investigation · Beech A36 · Refugio, TX · October 2, 2009

Accident · Minor injuriesLimited investigationFinal report
Date
October 2, 2009, 13:10 local (18:10 UTC)
Place
Refugio, TX
Injuries
1 minor, 2 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N991PPBeech A36
Defining event
Enroute-cruise: Fuel starvation
Weather
Visual (VMC) · Day
Status
Completed · report March 3, 2010
Report
Approved by Office Director
NTSB office
Central Region
Parties
FAA FSDO, Teledyne Continential Motors
FAA report
20091002020099A
Case key
74855

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.

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Probable cause

A total loss of engine power due to fuel starvation as a result of the pilot's improper fuel management. Contributing to the accident was the pilot's failure to follow the correct engine restart checklist.

Findings · 3

NTSB’s coded findings. Those marked are part of the probable cause; the rest are factors or other findings. Under each, the cases with the same finding.

Fluids: fuelAircraft › Fluids/misc hardware · Fluid managementBeech A36: 22 casesAll aircraft: 1,695 casesProbable cause
Use of equip/info: use of equip/systemPersonnel issues › Task performance · PilotBeech A36: 17 casesAll aircraft: 1,391 casesProbable cause
Use of equip/info: use of checklistPersonnel issues › Task performance · PilotBeech A36: 8 casesAll aircraft: 336 casesProbable cause

Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event is the one that best describes the accident. Under each, the cases with the same event anywhere in their sequence.

Analysis

During a cross-country flight the pilot tracked his fuel usage by watching the engine analyzer; however, about 180 miles from his destination airport the engine lost power and the pilot performed a forced landing, resulting in substantial to the airplane. During the descent the pilot unsuccessfully tried to restart the engine by switching the fuel selector between the right and left fuel tanks. An on-site examination of the airplane revealed that the that the airplane's left wing fuel tank contained about 2 cups of fuel and when the right wing fuel cap was removed, fuel would spill from the tank. An additional examination of the fuel selector, airframe, and an engine test run failed to reveal a preimpact anomaly that would have precluded a restart of the engine. The pilot later added that while trying to restart the engine he did not turn on the electric-driven fuel pump. Additionally, he noted that the checklist that he carried in the aircraft failed to mention the electric-driven fuel pump; however, he noted that the pilot's operating handbook (POH) did mention the electric pump.

Factual narrative

On October 2, 2009, approximately 1310 central daylight time, a single-engine, Beechcraft A-36 airplane, N991PP, was substantially damaged during a forced landing following a loss of engine power, near Refugio, Texas. The private pilot received minor injuries and the two passengers were not injured. The airplane was registered and operated by a private individual. The approximately 676 nautical-mile cross-country flight originated from the New Century AirCenter Airport (KIXD), Olathe, Kansas under visual meteorological conditions en route to the Corpus Christi International Airport (KCRP) Corpus Christi, Texas. About 180 miles from the destination airport, the pilot activated an instrument flight plan for the 14 Code of Federal Regulations Part 91 flight. According to the pilot, he departed KIXD with the fuel tanks "topped off", and that he managed the fuel en route by using the aircraft's engine analyzer. During the flight he switched between the left and right fuel tanks and recorded how much fuel was consumed. About four hours into the flight, the engine began to "sputter and lose power". The pilot asked for, and received a heading to the nearest airport from air traffic control. During the decent, the piloted switched from the right wing fuel tank to the left wing fuel tank, and then back to the right tank. However, he was unable to get the engine to restart. Unable to make the airport, the pilot elected to conduct an emergency landing in a field near the airport. The airplane collided with a bush before impacting terrain; the airplane then slid to a stop. The pilot and passengers were able to exit the airplane unassisted. The pilot added later, that while trying to restart the engine, he did not turn on the electric driven fuel pump. Additionally, he noted the checklist that he carried in the aircraft failed to mention the electric driven fuel pump; however, he noted that the pilot's operating handbook (POH) did mention the electric pump. The Federal Aviation Administration (FAA) Inspector, who responded to the accident site, reported that the airplane's right gear had been forced through the wing, and that the airplane sustained substantial damaged during the forced landing. He added that the airplane's left wing fuel tank contained, "2 cups of fuel" and when the fuel cap from the right wing was removed, fuel would spill from the tank. The wreckage was transported to a secure facility near Lancaster, Texas, for further examination. An examination was conducted by the NTSB IIC with a technical representative from Teledyne Continental Motors, on 23 October, 2009. The engine, with 81 hours since major overhaul, remained attached to the airframe. The engine/fuselage was placed on a trailer without the wings, which had been removed for transport. A fuel can was connected to the airplane's fuel system on the right side wing root. The airplane's propeller, which had been damaged in the accident, was replaced with a test propeller. Prior tostarting the engine, a visual engine inspection was conducted and no abnormalities were discovered. Additionally, to check for proper operation, the fuel selector valve was turned to the left and right positions. The engine was then started and ran for several minutes at various (idle to full) power settings. During the tests, the engine appeared to produce full power.

Aircraft

Registration
N991PP
Reported as
Beech A36
Category
Airplane
Serial number
E-914
Engine
Cont Motor IO 520 SERIES, 285 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
Aero Mark Jm LLC
Registered owner
Aero Mark Jm LLC
Airworthiness certificate
Standard, Normal
Departed
KIXD · New Century Air, KS
Destination
KCRP · Corpus Christi, TX
Flight plan
VFR/IFR

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
56
Injuries
Minor
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, With waivers/limitations
Last flight review
January 20, 2008
Seat
Left
Flight hours
1,142 total · 448 in this make and model · 860 as pilot in command · 26 in the last 90 days · 11 in the last 30 days · 4 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
30° at 11 knots
Visibility
10 statute miles
Lowest ceiling
12,000 ft overcast
Temperature
82 °F, dew point 72 °F
Altimeter
29.86 inHg
Observed at
KRKP, 17 nm away

Docket · 5

The files NTSB released with the investigation on November 23, 2009, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.1 MB in all.

FAA reports on this event · 1

The FAA’s own accident and incident reports, matched to the aircraft by N-number and date.