CEN15CA033

NTSB accident investigation · Piper PA-23-250 · Quincy, IL · October 26, 2014

Accident · No injuriesData collectionFinal report
Date
October 26, 2014, 14:20 local (19:20 UTC)
Place
Quincy, IL
Injuries
4 uninjured
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N62791Piper PA-23-250
Defining event
Enroute-descent: Fuel exhaustion
Weather
Visual (VMC) · Day
Status
Completed · report February 11, 2015
Report
Approved by Office Director
NTSB office
Central Region
Parties
Federal Aviation Administration - Springfield FSDO
FAA report
20141026018969A
Case key
90330

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

On this page

Probable cause

The pilot's improper fuel management, which resulted in the total loss of power to both engines due to fuel exhaustion and the subsequent forced landing in a field. Also causal to the accident was the pilot's decision to use the slower emergency hand-pump to extend the landing gear instead of the available carbon-dioxide blowdown system, which resulted in a landing without the landing gear fully extended.

Findings · 5

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 managementPiper PA-23-250: 3 casesAll aircraft: 1,695 casesProbable cause
Engine fuel and control: fuel distributionAircraft › Aircraft power plant · Capability exceededPiper PA-23-250: 1 caseAll aircraft: 55 casesProbable cause
Planning/preparation: fuel planningPersonnel issues › Task performance · PilotPiper PA-23-250: 3 casesAll aircraft: 719 casesProbable cause
Landing gear system: gear extension and retract sysAircraft › Aircraft systems · Incorrect use/operationPiper PA-23-250: 2 casesAll aircraft: 416 casesProbable cause
Use of equip/info: use of equip/systemPersonnel issues › Task performance · PilotPiper PA-23-250: 4 casesAll aircraft: 1,391 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

The pilot reported that the airplane departed with 122 gallons of fuel for the cross-country flight from Destin, Florida, to Quincy, Illinois. The airplane's two inboard wing fuel tanks, each having a 36 gallon capacity, were completely full before departure; however, in order to keep the airplane below its maximum gross weight at departure, the two outboard wing fuel tanks were each partially fueled with 25 gallons. The pilot reported that the inboard fuel tanks were used for engine startup, taxi, takeoff, and climb to the initial cruise altitude assigned by air traffic control. After reaching the initial cruise altitude, he switched to the outboard fuel tanks and leaned the mixture setting for optimal fuel consumption. About 2 hours into the flight, the pilot switched back to the inboard fuel tanks after the engines had consumed the useable fuel in the two outboard fuel tanks. The pilot reported that when the flight was about 7 miles from the destination airport, descending through 3,500 feet mean sea level, the right engine lost total power. The pilot feathered the right propeller, secured the right engine, and continued toward the planned destination. Shortly thereafter, the left engine lost total power and the pilot feathered the propeller and secured the engine. The pilot reported that he delayed extending the landing gear until the airplane cleared a row of trees that bordered the harvested soybean field that he selected for the forced landing. After clearing the trees, the pilot attempted to extend the landing gear by moving the landing gear selector handle to the down position; however, because the left engine was inoperative, a normal landing gear extension with the engine driven hydraulic pump was not possible. The pilot immediately attempted to extend the landing gear using the emergency hand-pump, but the airplane impacted terrain before the landing gear was fully extended. Upon contact with the terrain, the nose and left main landing gear collapsed. The left wing and fuselage sustained substantial damage during the forced landing. A postaccident examination of the airplane established that the inboard and outboard fuel tanks were void of any useable fuel. The pilot reported that the accident flight was about 4 hours 20 minutes in duration and that fuel exhaustion was the reason that both engines had lost total power. Before departing on the accident flight, he estimated that the flight would require about 118 gallons of fuel, and as such, there would be about 4 gallons of fuel remaining at the completion of the flight. However, after the accident, the pilot acknowledged that he failed to account for the 6.8 gallons of unusable fuel within the fuel system. Additionally, the airplane was equipped with an emergency carbon-dioxide blowdown system that the pilot could have used to rapidly extend the landing gear instead of the more laborious and time consuming emergency hand-pump. The pilot did not offer an explanation on why he choseto use the emergency hand-pump instead of the carbon-dioxide blowdown system. Had the landing gear been fully extended before landing, it is likely that the landing gear would not have collapsed.

Factual narrative

The pilot reported that the airplane departed with 122 gallons of fuel for the cross-country flight from Destin, Florida, to Quincy, Illinois. The airplane's two inboard wing fuel tanks, each having a 36 gallon capacity, were completely full before departure; however, in order to keep the airplane below its maximum gross weight at departure, the two outboard wing fuel tanks were each partially fueled with 25 gallons. The pilot reported that the inboard fuel tanks were used for engine startup, taxi, takeoff, and climb to the initial cruise altitude assigned by air traffic control. After reaching the initial cruise altitude, he switched to the outboard fuel tanks and leaned the mixture setting for optimal fuel consumption. About 2 hours into the flight, the pilot switched back to the inboard fuel tanks after the engines had consumed the useable fuel in the two outboard fuel tanks. The pilot reported that when the flight was about 7 miles from the destination airport, descending through 3,500 feet mean sea level, the right engine lost total power. The pilot feathered the right propeller, secured the right engine, and continued toward the planned destination. Shortly thereafter, the left engine lost total power and the pilot feathered the propeller and secured the engine. The pilot reported that he delayed extending the landing gear until the airplane cleared a row of trees that bordered the harvested soybean field that he selected for the forced landing. After clearing the trees, the pilot attempted to extend the landing gear by moving the landing gear selector handle to the down position; however, because the left engine was inoperative, a normal landing gear extension with the engine driven hydraulic pump was not possible. The pilot immediately attempted to extend the landing gear using the emergency hand-pump, but the airplane impacted terrain before the landing gear was fully extended. Upon contact with the terrain, the nose and left main landing gear collapsed. The left wing and fuselage sustained substantial damage during the forced landing.A postaccident examination of the airplane established that the inboard and outboard fuel tanks were void of any useable fuel. The pilot reported that the accident flight was about 4 hours 20 minutes in duration and that fuel exhaustion was the reason that both engines had lost total power. Before departing on the accident flight, he estimated that the flight would require about 118 gallons of fuel, and as such, there would be about 4 gallons of fuel remaining at the completion of the flight. However, after the accident, the pilot acknowledged that he failed to account for the 6.8 gallons of unusable fuel within the fuel system. Additionally, the airplane was equipped with an emergency carbon-dioxide blowdown system that the pilot could have used to rapidly extend the landing gear instead of the more laborious and time consuming emergency hand-pump. The pilot did not offer an explanation on why he chose touse the emergency hand-pump instead of the carbon-dioxide blowdown system.

Aircraft

Registration
N62791
Reported as
Piper PA-23-250
Category
Airplane
Serial number
27-7754028
Built
1976
Airframe hours
3,693.4
Engines
Lycoming IO-540-C4B5, 250 horsepower, reciprocatingLycoming IO-540-C4B5, 250 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Operator
Great River Aviation, LLC
Registered owner
Great River Aviation, LLC
Airworthiness certificate
Standard, Normal
Last inspection
Annual · June 27, 2014
Departed
DTS · Destin, FL
Destination
UIN · Quincy, IL
Flight plan
IFR
Airport
UIN · Quincy Regional Airport
Equipment
Stall warning system, Auto-pilot, Electronic multifunction display, Onboard weather

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
47
Injuries
None
Certificates
Commercial, Flight instructor
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 2, With waivers/limitations
Last flight review
October 11, 2014
Seat
Left
Restraint
3-point
Flight hours
1,499 total · 54 in this make and model · 1,325 as pilot in command · 15 in the last 90 days · 13 in the last 30 days · 4 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
140° at 10 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
72 °F, dew point 43 °F
Altimeter
29.85 inHg
Observed at
UIN, 2 nm away

Docket · 3

The files NTSB released with the investigation on January 29, 2015, on NTSB’s docket system: statements, records, photos and specialists’ reports. 2.2 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.