DEN04FA038

NTSB accident investigation · Beech B95 · Cedar City, UT · January 12, 2004

Accident · FatalField investigationFinal report
Date
January 12, 2004, 11:42 local (18:42 UTC)
Place
Cedar City, UT
Injuries
2 fatal
Damage
Destroyed
Phase of flight
Maneuvering
Aircraft
N9679RBeech B95
Weather
Visual (VMC) · Day
Status
Completed · report January 24, 2005
Report
Approved by Office Director
Parties
FAA FSDO, Textron Lycoming
FAA report
20040112000569A
Case key
58608

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

the pilot in command's (examinee) failure to maintain airspeed which resulted in a stall. Contributing to the accident was the inadequate supervision by the designated examiner.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Loss of control - in flightManeuvering
Airspeed - not maintainedPilot in commandCause
Stall/spin - inadvertentPilot in commandCause
Supervision - inadequateDesignated examinerFactor
In flight collision with terrain/waterDescent - uncontrolled
Terrain condition - open field

Analysis

The check ride flight departed from the airport at 1120. At approximately 1400, the airplane was reported overdue, and the local flight school launched some airplanes to initiate a search. According to radar data, the airplane appeared to be maneuvering at an altitude that varied between 8,200 feet msl and 9,000 feet msl and a groundspeed that varied between 40 knots and 200 knots. The last radar position at 1141:03 indicated an altitude of 8,900 feet msl and a ground speed of 6 knots. An on scene examination of the airplane revealed no anomalies.

Factual narrative

History of flight

On January 12, 2004, at 1142 mountain standard time, a Beech B95, N9679R, piloted by a commercial pilot applicant, was destroyed when it impacted terrain 16 miles north west of Cedar City Municipal Airport, (CDC) Cedar City, Utah. A post impact fire ensued. Visual meteorological conditions prevailed at the time of the accident. The local check ride was being conducted under the provision of Title 14 CFR Part 91 without a flight plan. The designated examiner and commercial rated examinee were fatally injured. The flight departed at 1120.

According to the owner of the airplane, he had flown down from Provo, Utah, with the examinee, and another student on the morning of the accident. Two check rides with the designated examiner were scheduled. The first check ride flight departed from CDC at 1120. At approximately 1400, the airplane was reported overdue, and the local flight school launched several airplanes to initiate a search. One of the search airplanes observed a column of smoke, which led them to the smoldering airplane at approximately 1600.

According to the National Track Analysis Program (NTAP) data, the airplane appeared to be maneuvering at an altitude that varied between 8,200 feet msl and 9,000 feet msl and at a groundspeed that varied between 40 knots and 200 knots. The last radar contact was made at 1141:03 at an indicated altitude of 8,900 feet msl and a ground speed of 6 knots.

Personnel information

The designated examiner held an airline transport pilot certificate with a multiengine rating, single engine land with commercial privileges, and a flight instructor's certificate with single, multiengine, and instrument ratings. He was issued a third class medical certificate on July 9, 2002. This certificate was under special issuance due to hypertension and a coronary artery bypass. The certificate contained no limitations. According to the last medical examination, the designated examiner estimated his flight time at 26,000 hours.

The examinee held a commercial certificate with airplane single engine land and instrument ratings. He was issued a first class medical certificate on September 17, 2001. The certificate contained the limitation "corrective lenses must be worn." According to the examinee's flight instructor, he had logged approximately 300 hours, eight of which were in multiengine airplanes. All of the examinee's multiengine experience was logged in the accident airplane.

Aircraft information

The airplane was a Beech B95, manufactured in 1960. It was equipped with two Lycoming O-360-A1A engines. Each engine was equipped with a Hartzel, 2-blade, full feathering, constant speed propeller.

The owner/operator of the airplane purchased it in October of 2003. Approximately 250 hours had been flown on the airplane between the time of purchase and the time of the accident.

Wreckage, recovery, and documentaton

The NTSB arrived at the scene at approximately 1300 on January 13, 2004 and began the on scene investigation.

The wreckage was located at 37 degrees 51.933 minutes north latitude and 113 degrees, 18.990 minutes west longitude; 16.4 statue miles north, north west of CDC. The airplane was located in an open, grassy, snow covered field at an elevation of 5,192 feet msl. The longitudinal axis of the airplane was oriented on a heading of 330 degrees. There were no ground scars, no debris field, and all of the airplanes major components were located at the accident site.

The front cockpit area and instrument panel was consumed by fire. The rear cabin area was charred and partially consumed by fire. The windscreen was fragmented. Fragments were found in front of and to the right and rear of the wreckage. There was no debris or windscreen fragments found to the left or left rear of the wreckage.

The empennage on the right side was crushed inward and torn from the top of the empennage to the bottom, along the side. From the empennage, rear, rudder continuity was established. Elevator continuity was not established. The right horizontal stabilizer was wrinkled 14 inches inboard from the tip. The left elevator wrinkled.

The wing flaps are operated by one flap motor and two flex shafts. According to the flex shaft position, the flaps were approximately 30 degrees. The flap lever in the cockpit was found in the "half way" position. The landing gear lever was found in the down or gear extended position. This lever is spring controlled and has a detent or locked position. On scene information indicated that the gear was down prior to impact.

The outboard engine mount on the left engine was broken. The inboard engine mount was bent to the right. The engine cowling was charred. The nose cone on the left engine showed aft crushing. The propeller blades on the left engine were labeled L-A and L-B for identification purposes only. Both blades appeared to be in the feathered position and were unremarkable.

The left aileron was charred on the inboard edge. Aileron continuity was not established due to impact damage. The outboard edge of the aileron and the left wing were bent.

The right wing leading edge was wrinkled. The riveting popped along the leading edge of the wing and the right fuel tank was compromised. The right flap was charred and partially consumed by fire. Several diagonal wrinkles were noted on the right elevator. The right inboard fuel tank was compromised and consumed by fire. Aileron continuity was not established due to impact damage. The right inboard fuel tank was compromised and consumed by fire. The right outboard fuel tank ruptured aft. Directly behind this rupture, a four-foot inboard section of the aileron and a small portion of the right flap were consumed by fire.

The right engine mounts were crushed/bent outboard. The right engine cowling was charred. The wing locker was charred and partially consumed by the fire. For identification purposes, the propeller blades were labeled R-A and R-B. Blade R-A was pointing straight up and unremarkable. Propeller blade R-B was bent back, underneath the engine and cowling and separated at the propeller hub. The nose cone on the right engine showed straight crushing.

A field examination of the engines was conducted at the scene. Engine continuity was established on the left engine. Due to impact damage, continuity was not established on the right engine. The left engine propeller appeared to be feathered and the blades were parallel with the leading edge of the wing (horizontal).

Medical & pathological information

An autopsy was performed on both pilots at the State of Utah, Department of Health, Office of the Medical Examiner, in Salt Lake City, Utah, on January 13, 2004. No evidence of physical incapacitation or impairment that would have been causal to the accident was found.

Toxicology was performed on the examinee. According to the CAMI (Civil Aero Medical Institute), report # 200400015001, the results were negative for cyanide, carbon monoxide, and ethanol. Doxylamine (found in Unisom Nighttime Sleep Aid) and pseudoephedrine (found in Sudafed) were detected in the liver and pseudoephedrine was detected in the kidneys.

Tests and research

Both propeller blades were sent to Hartzell Propeller for further examination. According to their report, the left propeller "had a light mark caused by contact between the link arm and bottom side of the counterweight. This mark occurred at a blade angle in the operating range," indicating that the blade was not fully feathered.

Fracture surfaces from the hub pilot tube on the right propeller indicated, "the blade was at a very low blade angle" at the time of impact.

Hartzell concluded that because of the negligible damage to the left blade, "it appeared to have no power at the time of impact. The right propeller appeared to have low power or no power at the time of impact."

Additional data

Parties to the investigation include the Feder

Aircraft

Registration
N9679R
Reported as
Beech B95
Category
Airplane
Serial number
TD351
Airframe hours
977.1
Engines
Textron Lycoming O-360-A1A, 180 horsepower, reciprocatingTextron Lycoming O-360-A1A, 180 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Flight test · Part 91
Registered owner
Flight Club LLC
Airworthiness certificate
Standard, Normal
Last inspection
100 hour · November 24, 2003
Departed
CDC · Cedar City, UT
Destination
CDC
Airport
CDC · Cedar City Muni

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 · 2

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
23
Injuries
Fatal
Certificate
Commercial
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Seat
Left
Toxicology
Performed
Flight hours
300 total · 8 in this make and model · 240 as pilot in command · 1 in the last 24 hours
Role
Check pilot
Age
69
Injuries
Fatal
Certificates
Commercial, Airline transport, Flight instructor
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 3, Valid Medical--w/ waivers/lim
Last flight review
October 31, 2003
Seat
Right
Flight hours
28,500 total · 9,500 as pilot in command · 1 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Wind
0° at 4 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
34 °F, dew point 21 °F
Altimeter
30.09 inHg
Observed at
CDC, 16 nm away

FAA reports on this event · 1

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