CEN18LA075

NTSB accident investigation · Piper PA 28-236 · Tishomingo, OK · January 13, 2018

Accident · Serious injuriesLimited investigationFinal report
Date
January 13, 2018, 11:30 local (17:30 UTC)
Place
Tishomingo, OK
Injuries
1 serious
Damage
Substantial damage
Phase of flight
Enroute
Aircraft
N4345KPiper PA 28-236
Defining event
Enroute: Fuel exhaustion
Weather
Visual (VMC) · Day
Status
Completed · report November 15, 2018
Report
Approved by Office Director
NTSB office
Central Region
Parties
Federal Aviation Administration
FAA report
20180113000779A
Case key
96611

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 inadequate preflight fuel planning and in-flight fuel monitoring and his decision to take off with an unverified amount of fuel, which resulted in fuel exhaustion and a subsequent impact with trees during an attempted forced landing.

Findings · 6

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.

Planning/preparation: fuel planningPersonnel issues › Task performance · PilotPiper PA-28-236: 1 caseAll aircraft: 719 casesProbable cause
Fluids: fuelAircraft › Fluids/misc hardware · Fluid managementPiper PA-28-236: 2 casesAll aircraft: 1,695 casesProbable cause
Object/animal/substance: tree(s)Environmental issues › Physical environment · Contributed to outcomePiper PA-28-236: 2 casesAll aircraft: 933 cases

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 private pilot departed on a cross-country flight; he reported that 35 to 40 gallons of fuel were in the airplane's fuel tanks for a flight that he thought would require 20 gallons of fuel. As the airplane was nearing the destination, the pilot was concerned about the fuel level in the left tank because the fuel gauge indicated that the tank was between one-quarter full and empty and no fuel remained in the right tank, which the pilot had intentionally run dry. The pilot elected to divert to ensure that the airplane would have adequate fuel to complete the flight to the destination. Upon landing at the diversion airpark, the pilot learned that the airpark had no fuel. The pilot subsequently took off from the airpark, and the airplane reached an altitude of about 1,500 ft above ground level when the engine "sputtered." The pilot attempted to return to the airpark, but the airplane could not clear the trees in the area. The pilot attempted a forced landing, but the airplane impacted the trees and subsequently impacted terrain. The airplane was in an inverted position at the time of impact. The pilot reported that the left tank "apparently goes empty somewhere prior to the E [empty] on the fuel gauge." However, the pilot did not mention whether he visually checked the amount of fuel before leaving the diversion airpark. Thus, the pilot likely departed without sufficient fuel on board to complete the flight to another diversion airpark. Further, the fuel amount was lower than the pilot expected during the flight, which was consistent with poor preflight fuel planning and in-flight fuel monitoring.

Factual narrative

On January 13, 2018, about 1130 central standard time, a Piper PA 28-236 airplane, N4345K, impacted terrain during a forced landing following an inflight loss of engine power near Tishomingo, Oklahoma. The pilot was seriously injured. The airplane sustained substantial fuselage damage. The airplane was registered to Piper-Dakota LLC and operated by the pilot as a 14 Code of Federal Regulations Part 91 personal flight. Day visual meteorological conditions prevailed in the area about the time of the accident, and the flight was operated not operated on a flight plan. The flight originated about 1000 from the Memorial Field Airport (HOT), near Hot Springs, Arkansas, and was destined for the Ardmore Downtown Executive Airport, near Ardmore, Oklahoma.According to the pilot, he departed from HOT with about 35 to 40 gallons of fuel between the left and right fuel tanks. The pilot estimated that the flight would require 20 gallons of fuel. As he was nearing the destination the pilot was concerned about the fuel level in the left tank as it indicated between 1/4 full and empty. There was also no fuel remaining in the right tank as he intentionally ran it dry. The pilot elected to divert to the Tishomingo Airpark (0F9), near Tishomingo, Oklahoma, to ensure the airplane had adequate fuel to complete the flight to Ardmore. The pilot said that upon landing he found out that there was no fuel at 0F9 and that it had not had any fuel for many months. An airpark attendant advised that there was no place nearby to obtain fuel and that the pilot should try the next available airport. The pilot subsequently took off from 0F9. When the airplane reached an altitude of about 1,500 ft above ground level, the engine "sputtered" as if out of fuel. The pilot immediately turned back to the airport. However, the airplane was at an altitude where it could not clear the trees in area. The airplane impacted the trees and subsequently impacted terrain inverted. The pilot did not indicate in his accident report that he visually checked the fuel level before departing 0F9. However, he stated that the "left tank apparently goes empty somewhere prior to the "E" on the fuel gauge" and that the gauges were inaccurate. Federal Aviation Regulation Part 23.1337, Powerplant Instruments Installation, in part stated, "Each fuel quantity indicator must be calibrated to read ''zero'' during level flight when the quantity of fuel remaining in the tank is equal to the unusable fuel supply."

Aircraft

Registration
N4345K
Reported as
Piper PA 28-236
Category
Airplane
Serial number
28-8411012
Built
1984
Airframe hours
2,128
Engine
Lycoming O-540-J3A5D, 235 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · May 2, 2017
Departed
HOT · Hot Springs, AR
Destination
1F0 · Ardmore, OK
Equipment
Stall warning system, Auto-pilot, Satellite tracking device

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
72
Injuries
Serious
Certificate
Private
Airplane ratings
Single-engine land
Medical
Class 3, Without waivers/limitations
Last flight review
January 1, 2017
Seat
Left
Restraint
3-point
Flight hours
634 total · 522 in this make and model

Weather

Conditions
Visual (VMC) · Day
Wind
340° at 3 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
34 °F, dew point 12 °F
Altimeter
30.64 inHg
Observed at
KADM, 18 nm away

Docket · 2

The files NTSB released with the investigation on March 19, 2018, on NTSB’s docket system: statements, records, photos and specialists’ reports. 4.7 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.