# NTSB ERA13LA331: Beech A36, N117HB, Tupelo, MS, July 20, 2013 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Limited investigation · Final report - Date: July 20, 2013, 13:09 local (18:09 UTC) - Place: Tupelo, MS - Coordinates: 34.276943, -88.769996 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=34.2769&lon=-88.7700&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Defining event: [Approach-VFR pattern final: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341) - Highest injury: Minor injuries - Injuries: 1 minor - Status: Completed, report July 30, 2014 - Report: Approved by Office Director - NTSB office: Eastern Region Aviation - Parties: CMI, FAA/FSDO - NTSB case key (mKey): 87545 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=ERA13LA331 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/87545/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=87545 - Page: https://openairdocs.org/ntsb/ERA13LA331 ## Probable cause The pilot’s improper fuel management, which resulted in a total loss of engine power due to fuel starvation. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Planning/preparation: fuel planning](https://openairdocs.org/ntsb-findings/02061030): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Beech A36, 9 cases](https://openairdocs.org/ntsb-findings/02061030/cases.md?model=1151604), [All aircraft, 719 cases](https://openairdocs.org/ntsb-findings/02061030/cases.md) - [Fluids: fuel](https://openairdocs.org/ntsb-findings/01071010): Aircraft › Fluids/misc hardware · Fluid level (probable cause); cases with it: [Beech A36, 22 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md?model=1151604), [All aircraft, 1,695 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md) - [Fuel system: fuel selector/shutoff valve](https://openairdocs.org/ntsb-findings/01022823): Aircraft › Aircraft systems · Incorrect use/operation (probable cause); cases with it: [Beech A36, 2 cases](https://openairdocs.org/ntsb-findings/01022823/cases.md?model=1151604), [All aircraft, 176 cases](https://openairdocs.org/ntsb-findings/01022823/cases.md) - [Use of equip/info: use of equip/system](https://openairdocs.org/ntsb-findings/02063015): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Beech A36, 17 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md?model=1151604), [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Approach-VFR pattern final: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341) (defining event); cases with it: [Beech A36, 56 cases](https://openairdocs.org/ntsb-events/341/sequence.md?model=1151604), [All aircraft, 3,820 cases](https://openairdocs.org/ntsb-events/341/sequence.md) - [Approach-VFR pattern final: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Beech A36, 47 cases](https://openairdocs.org/ntsb-events/440/sequence.md?model=1151604), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) - [Landing: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Beech A36, 78 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=1151604), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis While the airplane was on final approach to the destination airport about 600 feet above ground level, the engine suddenly lost power. The pilot subsequently made a forced landing, and the airplane impacted the ground, became airborne, crossed a road, and then came to rest short of the intended runway. First responders reported that they found the fuel selector valve positioned to the left tank and that they observed fuel leaking from the left wing; however, an exact amount of fuel could not be ascertained. The recovery company reported that the right wing fuel tank contained 17 gallons of fuel and that the left wing fuel tank contained less than 1 gallon of fuel. Postaccident examination revealed no evidence of any mechanical malfunctions or failures that would have precluded normal operation. Although blue streaking was observed on the aft portion of the left wing, it could not be determined if the blue streaks were due to fuel leaking during the flight or the accident sequence or before the day of the accident. Examination of the engine revealed carbon deposits on all of the cylinders' piston faces, which is consistent with operating the engine at too lean of a fuel mixture. Following a normal engine test run, minimal carbon deposits were noted. Although some fuel was in the left wing tank at the time of the accident, it was likely less than the usable amount required, as indicated by the lean fuel mixture at the engine; thus, it is likely that the total loss of engine power was due to fuel starvation. ## Factual narrative According to fuel records, on June 30, 2013 the airplane was fueled with 40.3 gallons of aviation fuel. However, according to the recovery company, the right wing had about 17 gallons of fuel and the left wing had less than 1 gallon of fuel on board. A JP Instruments Inc., EDM-700 unit, was removed from the airplane and sent to the NTSB Recorders Laboratory for download. The data indicated that the engine was operating at a steady rate. About one minute prior to the end of the recording the exhaust gas temperature reading indicated a slight rise followed by a steady decrease to the end of the data and no other abnormal indications were noted. Engine Examination The engine was removed from the airplane, crated, and sent to the engine manufacturer for examination. On November 12, 2013 the engine was examined and mounted in a test cell for an engine run with oversight provided by the NTSB investigator. The examination revealed carbon deposits on all of the piston faces prior to the engine run, which were consistent with operating the engine at too lean of a fuel mixture. Following the engine run there were little carbon deposits noted on the piston faces. More details about the examinations can be found in the "Engine Examination Report" in the public docket for this accident. The 6-seat, low wing, single engine, airplane with retractable landing gear, was manufactured in 1978. It was powered by a Teledyne Continental IO-550-B(4), 300-hp engine. The most recent annual inspection was conducted on July 26, 2012, and at the time of the accident, the airplane had accrued 2,670.7 hours. The most recent engine maintenance logbook entry was dated March 19, 2013, and , indicated an engine total time and time since overhaul of 1,481.35 hours. A work order, dated April 10, 2013, was located that revealed the right hand fuel cap was replaced and the left hand fuel cap o-rings were lubricated. On July 20, 2013, about 1309 central daylight time, a Beech A36, N117HB, experienced a total loss of engine power while on approach for landing at Tupelo Regional Airport (TUP), Tupelo, Mississippi. The pilot subsequently made a forced landing, impacting the ground prior to the airport, the airplane became airborne, crossed a road, and impacted the ground again prior to the intended landing runway. The private pilot sustained minor injuries. The airplane sustained substantial damage to the left wing and forward portion of the fuselage. The airplane was registered to and operated by a private individual under the provisions of Title 14 Code of Federal Regulations Part 91 as a personal flight. Visual meteorological conditions prevailed and no flight plan had been filed for the flight that originated from Birmingham-Shuttlesworth International Airport (BHM), Birmingham, Alabama about 1200. According to the pilot, he departed TUP earlier in the day and flew direct to BHM. While on final approach to runway 18 at TUP the engine lost power about 600 feet above ground level. Theairplane impacted the ground in an off airport open field, bounced back into the air, crossed a road, and landed inside the airport fence. Once the airplane came to rest, he turned the ignition switch to "OFF" and exited the airplane. The pilot further reported that on a previous flight, fuel was observed streaming out of the right fuel tank cap and that he had subsequently replaced only the right fuel cap. According to first responders, the fuel selector valve was turned to the left fuel tank and fuel was observed leaking from the left wing. According to photographs provided by the airport authority, blue fluid was evident on the underside of the left wing and the left wing's flap. Initial examination by a Federal Aviation Administration inspector revealed that the airplane came to rest approximately 1,400 feet from the beginning of the displaced threshold for runway 18. The initial impact location was approximately 800 feet prior to where the airplane came to rest. According to photographs provided by the first responders, two of the three propeller blades exhibited no curling or S-bending and the other propeller blade was bent aft about midspan. The pilot, age 54, held a private pilot certificate with ratings for airplane single-engine land, and instrument airplane. He held a third-class medical certificated issued August 22, 2012 with the limitation that he possess glasses for near vision. The pilot reported a total flight time of 1,067 hours, with 411.6 hours in the make and model of the accident airplane. His most recent flight review was conducted in a Beech A36 on May 22, 2013. ## Aircraft - Registration: [N117HB](https://openairdocs.org/deregistered/N117HB-2019-03-25), registration cancelled 2019-03-25, S/N E-1316, built 1978 (OpenAirDocs) - Reported make and model: BEECH A36 - Registry model: [Beech A36](https://openairdocs.org/model/beech-a36) (registry code 1151604) (OpenAirDocs) - Registry engine: [Continental IO-520 series](https://openairdocs.org/engine/continental-io-520-series) (registry code 17032, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: E-1316 - Airframe hours: 2671 - Engines: CONT MOTOR IO-550B4 285 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Airworthiness certificate: Standard, Utility; Standard, Normal - Last inspection: Annual, July 26, 2012, 24 hours before - Departed: BHM, Birmingham, AL - Destination: TUP, Tupelo, MS - Airport: TUP, Tupelo Regional Airport, runway 18, 6,502 × 150 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 54; injuries: minor; private; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; last flight review May 22, 2013; seat: left; restraint: lap only; flight hours: 1,067 total, 412 in this make and model, 814 as pilot in command, 23 in the last 90 days, 6 in the last 30 days, 2 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 200° at 6 knots - Visibility: 10 statute miles - Lowest ceiling: 4,400 ft broken - Temperature: 88 °F, dew point 70 °F - Altimeter: 29.96 inHg - Observed at: TUP ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20130720016199A](https://openairdocs.org/incident/20130720016199A), Jul 20, 2013: Beech A36, Tupelo, MS, Substantial damage. Pilot reported that on final approach to runway 18 at Tupelo Regional Airport, (tup) in Tupelo, MS the aircraft lost engine power at approximately 600 feet off… ## Docket (17 files) The files NTSB released with the investigation on March 14, 2014, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=87545. 11.8 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 410 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40405920&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Memorandum of Record - Telephone Interview with Pilot (item 2, .PDF, 108 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397765&FileExtension=.PDF&FileName=Memorandum%20of%20Record%20-%20Telephone%20Interview%20with%20Pilot-Master.PDF - Pilot Written Statement to FAA (item 3, .PDF, 104 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397653&FileExtension=.PDF&FileName=Pilot%20Written%20Statement%20to%20FAA-Redacted.PDF - Engine Examination Report (item 4, .PDF, 11 photos, 3.6 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40405971&FileExtension=.PDF&FileName=Engine%20Examination%20Report-Redacted.PDF - Tupelo Weather (item 5, .PDF, 130 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397648&FileExtension=.PDF&FileName=Tupelo%20Weather-Master.PDF - Work Orders for Fuel Cap and Engine Cylinder (item 6, .PDF, 730 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40405919&FileExtension=.PDF&FileName=Work%20Orders%20for%20Fuel%20Cap%20and%20Engine%20Cylinder-Redacted.PDF - Fuel Receipt (item 7, .PDF, 59 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397669&FileExtension=.PDF&FileName=Fuel%20Receipt-Redacted.PDF - Email from Recovery Company on Fuel (item 8, .PDF, 66 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40405922&FileExtension=.PDF&FileName=Email%20from%20Recovery%20Company%20on%20Fuel-Redacted.PDF - Reports from Local Agencies - Tupelo Airport Authority (item 9, .PDF, 321 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397667&FileExtension=.PDF&FileName=Reports%20from%20Local%20Agencies%20-%20Tupelo%20Airport%20Authority-Redacted.PDF - Statement of Party Representatives to NTSB Investigation (item 10, .PDF, 563 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40405921&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF - Release of Aircraft Wreckage, NTSB Form 6120.15 (item 11, .PDF, 733 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40407145&FileExtension=.PDF&FileName=Release%20of%20Aircraft%20Wreckage,%20NTSB%20Form%206120.15-Redacted.PDF - Photo 1: Left Side of Airplane at Rest (Courtesy of the FAA) (item 12, .PDF, 876 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397649&FileExtension=.PDF&FileName=Photo%201%3A%20Left%20Side%20of%20Airplane%20at%20Rest%20(Courtesy%20of%20the%20FAA)-Master.PDF - Photo 2: Right Side of Airplane at Rest (Courtesy of the FAA) (item 13, .PDF, 1.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397650&FileExtension=.PDF&FileName=Photo%202%3A%20Right%20Side%20of%20Airplane%20at%20Rest%20(Courtesy%20of%20the%20FAA)-Master.PDF - Photo 3: Forward View of Airplane at Rest Looking Back Towards the Direction of Travel (Courtesy of the FAA (item 14, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397651&FileExtension=.PDF&FileName=Photo%203%3A%20Forward%20View%20of%20Airplane%20at%20Rest%20Looking%20Back%20Towards%20the%20Direction%20of%20Travel%20(Courtesy%20of%20the%20FAA-Master.PDF - Photo 4: Fuel Tank Selection on Left Tank as Found (Courtesy of the Tupelo Airport) (item 15, .PDF, 1.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40397652&FileExtension=.PDF&FileName=Photo%204%3A%20Fuel%20Tank%20Selection%20on%20Left%20Tank%20as%20Found%20(Courtesy%20of%20the%20Tupelo%20Airport)-Master.PDF - Engine Data Monitor - Factual Report (item 16, .PDF, 406 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40409962&FileExtension=.PDF&FileName=Engine%20Data%20Monitor%20-%20Factual%20Report-Master.PDF - Attachment 1 - Engine Data Monitor Factual Report (item 17, .CSV, 97 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40409963&FileExtension=.csv&FileName=Attachment%201%20-%20Engine%20Data%20Monitor%20Factual%20Report-Master.csv From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.