# NTSB GAA19CA587: Beech 36, N5836B, Lubbock, TX, September 25, 2019 - Type: NTSB accident investigation - Classification: Accident · No injuries · Data collection · Final report - Date: September 25, 2019, 07:15 local (12:15 UTC) - Place: Lubbock, TX - Coordinates: 33.663612, -101.820556 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=33.6636&lon=-101.8206&mi=10 - Phase of flight: [Takeoff](https://openairdocs.org/ntsb-phases/300) (OpenAirDocs' grouping) - Defining event: [Takeoff: Loss of control in flight](https://openairdocs.org/ntsb-events/240) - Highest injury: No injuries - Injuries: 1 uninjured - Status: Completed, report March 17, 2020 - Report: Approved by Office Director - NTSB office: General Aviation Accidents - Parties: FAA - NTSB case key (mKey): 100411 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=GAA19CA587 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/100411/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=100411 - Page: https://openairdocs.org/ntsb/GAA19CA587 ## Probable cause The pilot's improper pitch trim setting during takeoff in a left quartering tailwind, which resulted in the airplane abruptly pitching up and subsequently experiencing an aerodynamic stall. Contributing to the accident was the pilot's failure to follow a preflight checklist and verify that the elevator trim tab was in the takeoff position. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md) - [Performance/control parameters: pitch control](https://openairdocs.org/ntsb-findings/01062022): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [All aircraft, 526 cases](https://openairdocs.org/ntsb-findings/01062022/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: [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) - [Performance/control parameters: angle of attack](https://openairdocs.org/ntsb-findings/01062042): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [All aircraft, 990 cases](https://openairdocs.org/ntsb-findings/01062042/cases.md) - [Wind: tailwind](https://openairdocs.org/ntsb-findings/03034015): Environmental issues › Conditions/weather/phenomena · Effect on operation (probable cause); cases with it: [All aircraft, 594 cases](https://openairdocs.org/ntsb-findings/03034015/cases.md) - [Action: forgotten action/omission](https://openairdocs.org/ntsb-findings/02041035): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [All aircraft, 440 cases](https://openairdocs.org/ntsb-findings/02041035/cases.md) - [Use of equip/info: use of checklist](https://openairdocs.org/ntsb-findings/02063030): Personnel issues › Task performance · Pilot (probable cause); cases with it: [All aircraft, 336 cases](https://openairdocs.org/ntsb-findings/02063030/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Takeoff: Loss of control in flight](https://openairdocs.org/ntsb-events/240) (defining event); cases with it: [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md) - [Takeoff: Aerodynamic stall/spin](https://openairdocs.org/ntsb-events/241); cases with it: [All aircraft, 1,529 cases](https://openairdocs.org/ntsb-events/241/sequence.md) - [Takeoff: Attempted remediation/recovery](https://openairdocs.org/ntsb-events/060); cases with it: [All aircraft, 1,422 cases](https://openairdocs.org/ntsb-events/060/sequence.md) - [Takeoff: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis The pilot reported that, during the takeoff roll and while the airplane was about 60 knots, it lifted off in a nose-high attitude, and the stall warning horn actuated. He added that, about 20 ft above ground level, the airplane rotated to the right, but he overcorrected, and the left wingtip struck the runway. Shortly after, he landed the airplane without further incident. The airplane sustained substantial damage to the left wing. The pilot reported that there were no preaccident mechanical failures or malfunctions with the airplane that would have precluded normal operation. The pilot added that postaccident examination of the airplane revealed that the elevator trim was set to nose high and that he should have used a pretakeoff checklist to verify that the elevator trim was set to the takeoff position. ## Factual narrative The pilot reported that, during the takeoff roll, about 60 knots, the airplane lifted off in nose high attitude and the stall warning horn actuated. About 20 feet above the ground, the airplane rotated to the right, but he overcorrected, and the left-wing tip struck the runway. Shortly after, he landed the airplane without further incident. The airplane sustained substantial damage to the left wing. The pilot reported that there were no preaccident mechanical failures or malfunctions with the airplane that would have precluded normal operation. The automated weather observation station located on the airport reported that, about 15 minutes before the accident, the wind was 230° at 9 knots. The pilot reported the wind was calm. The airplane departed from runway 35L. The pilot added that post-accident the elevator trim was found set to nose high, and that he should have used a pre-takeoff checklist to verify the elevator trim was set to the takeoff position. ## Aircraft - Registration: N5836B (not matched to a registry record) - Reported make and model: Beech 36 (B36TC) - Category: Airplane - Serial number: EA558 - Year built: 1994 - Airframe hours: 2083 - Engines: Continental IO-520 300 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: We Gone Llc - Registered owner: We Gone Llc - Airworthiness certificate: Standard, Utility; Standard, Normal - Last inspection: Annual, February 11, 2019 - Departed: LBB, Lubbock, TX - Destination: LBB, Lubbock, TX - Airport: LBB, Lubbock Preston Smith Intl, runway 35L, 11,500 × 150 ft, concrete - Equipment: Onboard weather, Electronic multifunction display, Auto-pilot, ADS-B, Stall warning system ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 44; injuries: none; private; airplane ratings: single-engine land; medical: class 3, with waivers/limitations; last flight review May 25, 2019; seat: left; restraint: 3-point; flight hours: 178 total, 178 as pilot in command, 33 in the last 90 days, 5 in the last 30 days - Check pilot; age 21; injuries: none; private, flight instructor; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, without waivers/limitations; last flight review July 20, 2019; seat: right; restraint: 3-point; flight hours: 340 total, 340 as pilot in command, 85 in the last 90 days, 43 in the last 30 days, 10 in the last 24 hours ## Weather - Conditions: Day - Wind: 230° at 9 knots - Visibility: 10 statute miles - Temperature: 72 °F, dew point 63 °F - Altimeter: 29.92 inHg - Observed at: KLBB ## 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 20190925013709A](https://openairdocs.org/incident/20190925013709A), Sep 25, 2019: Beech B36TC, Lubbock, TX, Substantial damage. On September 25, 2019, at 0715 CDT, a Beechcraft B36TC bearing registration number N5836B, registered to a private owner, experienced a loss of control and… ## Docket (2 files) The files NTSB released with the investigation on January 16, 2020, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=100411. 735 KB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 634 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40479973&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Master.PDF - Accident Photo (item 2, .PDF, 101 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40479974&FileExtension=.PDF&FileName=Accident%20Photo-Master.PDF 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.