LAX07FA049

NTSB accident investigation · Beech B36TC · Buena Park, CA · November 27, 2006

Accident · Serious injuriesField investigationFinal report
Date
November 26, 2006, 17:00 local (Nov 27, 2006, 01:00 UTC)
Place
Buena Park, CA
Injuries
2 serious
Damage
Substantial damage
Phase of flight
Approach
Aircraft
N3144DBeech B36TC
Weather
Visual (VMC) · Night
Status
Completed · report November 29, 2007
Report
Approved by Office Director
Parties
Federal Aviation Administration
FAA report
20061126025359A
Case key
64931

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

a fuel starvation induced loss of engine power due to pilot's inadequate fuel system management.

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 engine powerApproach - vfr pattern - downwind
Fluid,fuel - starvationCause
Fuel management - inadequatePilot in commandCause
Fuel tank selector position - improperPilot in commandCause
Fuel supply - not selectedPilot in commandCause
Forced landingDescent - uncontrolled
Terrain condition - residential area
In flight collision with objectDescent - uncontrolled
Object - wall/barricade
Object - residence

Analysis

The airplane experienced a loss of engine power and descended into a single family residence 0.3 miles from the destination airport. The pilot estimated a total flight time en route of 2 hours 38 minutes, with the total fuel on board equating to 4 hours 53 minutes. While in traffic pattern, the engine experienced a loss of power and the pilot declared an emergency. A witness stated that he noticed the accident airplane flying low and the propeller appeared as though it was not producing power. Fueling records at the departure airport disclosed that the aircraft was last fueled immediately prior to departure with the addition of 45 gallons of 100LL aviation fuel. According to the pilot, the addition of the fuel filled the aircraft tanks to a total of 90 gallons (45 in each tank). The fueler was contacted several days after the accident. He indicated that he did not fill each tank to the maximum capacity, rather he evenly distributed the 45 gallons of fuel to each side. Each wing's total fuel capacity was 54 gallons, of which 3 gallons were unusable. Each wing was equipped with a fuel quantity sight gage that reads within the calibrated area of 25 to 30 gallons. The right wing was impact damaged with numerous perforations. The inboard fuel bladder was drained via the bottom sump and found to have about 1 gallon of fuel. The left wing was separated from the fuselage. Removal of the inspection panels on the left wing revealed that the fuel bladders were intact. There appeared to be only several ounces of fuel within the outboard bladder; no other fluid was found in the left wing. The fuel selector was found in the "OFF" position and had been turned to OFF by a first responder. The engine was examined and test run; no mechanical malfunctions or failures were found with the engine that would have precluded it from operating normally. The non-volatile memory of an engine data management system revealed that the accident flight encompassed a duration of 3.66 hours. The total fuel used during the last flight was 64.3 gallons. Shortly before the accident, the engine's fuel flow dropped from 15.9 to 7.1 gallons per hour. Thereafter, the fuel flow was between .3 and 6.2 gallons per hour. The battery voltage remained fairly constant, consistent with the electrical system operating normally. The pre-crash integrity of the fuel system could not be verified due to the extent of airplane damage incurred during the accident.

Factual narrative

History of flight

On November 26, 2006, about 1700 Pacific standard time, a Beech B36TC, N3144D, experienced a loss of engine power and descended into a single family residence in Buena Park, California. The airplane and a portion of the private residence sustained substantial damage. The private pilot and passenger sustained serious injuries; there were no injuries to people on the ground. The pilot was operating the airplane under the provisions of 14 CFR Part 91. Visual meteorological conditions prevailed, and an instrument flight plan was filed. The personal cross-country flight originated from the Benton Field Airport (uncontrolled), Redding, California, about 1400, with a planned destination of Fullerton Municipal Airport (controlled), Fullerton, California.

The National Transportation Safety Board investigator-in-charge (IIC) reviewed the pilot's flight plan and cross-country preparation documents that were within the wreckage. The documents indicated that the pilot intended to fly the airplane from Redding en route to Fullerton at 9,000 feet mean sea level (msl) at a true airspeed of 188 knots. The pilot had estimated a time en route of 2 hours 38 minutes, with the total fuel on board listed as 4 hours 53 minutes.

The IIC interviewed a Fullerton air traffic controller who was in communication with the pilot. He stated that the accident airplane was established on the downwind leg of the traffic pattern for runway 24. The pilot transmitted that the engine experienced a loss of power and subsequently declared an emergency. The controller cleared the pilot for a straight-in approach to runway 06, and made visual contact with the descending airplane. Minutes later, the pilot transmitted a radio call stating that he would be unable to make it to the runway.

During a conversation with the IIC, a witness stated that he noticed the accident airplane as he was egressing his car that he had just parked in front of a residence [adjacent to the accident site]. The airplane was flying low and moving directly toward his location, giving the appearance that it might collide with his car. He noted that the airplane appeared to be in a left bank [from the pilot's perspective], with the propeller windmilling in front, as if it were not producing power.

The pilot submitted a Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1/2 more than 4 months after the accident. He stated that due to his injuries sustained in the accident, he does not recall "the flight, the emergency, the crash landing, or post crash extrication."

Personnel information

According to the Federal Aviation Administration (FAA) Airman and Medical records files, the pilot held a private pilot certificate with airplane ratings for single engine land and instrument flight. The pilot was issued a third-class medical certificate on March 22, 2004, with the limitation that he must wear corrective lenses.

In a written statement, the pilot reported his flight time as 2,138 hours total flight experience, of which 750 hours were flown in the same make and model as the accident airplane.

The pilot added that he had flow the same route as the accident flight numerous times and experienced no difficulties or anomalies.

Airplane information

The IIC reviewed both the airplane's maintenance logbooks and material maintained by the FAA in the Aircraft and Registry files. The Beech B36TC single engine airplane, serial number EA-472, was manufactured in 1987. The most recent annual inspection of the airframe and engine was performed on September 21, 2006, corresponding to 31.5 flight hours prior to the accident. The pilot reported that the Teledyne Continental Motors TSIO-520-R engine, serial number 294309-R12, had accumulated a total time of 1,195 hours and 175 hours since last major overhaul.

Fuel

Fueling records at the Redding airport disclosed that the aircraft was last fueled prior to departure with the addition of 45 gallons of 100LL aviation fuel. According to the pilot, the addition of the fuel filled the aircraft tanks to a total of 90 gallons (45 in each tank). The staff member that fueled the airplane was contacted several days after the accident. He indicated that he did not fill each tank to the maximum capacity, rather he evenly distributed the 45 gallons of fuel to each side, as per the pilot's request.

According to the airplane's Pilot Operator's Handbook (POH) the 108-gallon fuel system consisted of two interconnected bladder-type fuel cells located in each wing leading edge. Each wing's total fuel capacity was 54 gallons, of which 3 gallons were unusable. Each wing was equipped with a fuel quantity sight gage that read within the calibrated areas of 25 to 30 gallons.

The POH further revealed that the airplane was equipped with a fuel selector located forward and to the left of the pilot's seat. It was equipped with an "OFF," "LEFT MAIN," and "RIGHT MAIN" selection. The POH indicated that during takeoffs and landings the fuel selector should be positioned to the tank that contains the greater amount of fuel. It noted that to select the "OFF" position the pilot must depress a lockout spring, while rotating the handle to the full counterclockwise detent.

Wreckage and impact

On November 27, 2006, the Safety Board IIC, as well as several inspectors from the Federal Aviation Administration, completed the on-scene investigation.

The accident site was in a residential area, about 2,100 feet from the approach end of runway 06, on a bearing of 045 degrees. The surrounding area was densely populated with residences. A path of wreckage debris, ground scars, and property destruction was noted extending on a 075-degree magnetic bearing, over a stretch of 150 feet through two residences and their respective back yards. The main wreckage had come to rest partially inside an empty bedroom with the empennage section in the back yard of the approximate 1,600-square-foot single-story house.

Power lines about 40 feet in height were located at the beginning of the debris field, about 145 feet west of the main wreckage. The power lines were oriented in a north-south direction and appeared not to have sustained any damage. A portion of the airplane's left wing tip was located between the power lines and the apex of the westerly residence's roof, which was identified as the first point of impact. The airplane's left wing (including the detached flap and aileron) and left horizontal stabilizer were found in the west residence's back yard and swimming pool.

A cinderblock cement wall that ran north-south about 5.5 feet tall separated the two residential properties. The wall had sustained damage consisting of two semicircular u-shaped holes, both of which were about 5 feet in diameter along the top of the wall and spaced about 3 feet apart. Transmission lines were located above the wall with the lowest wires between 14 and 16 feet (.5 inches in diameter), the middle wires about 20 feet, and the tallest wires at 40 feet. The lowest wire was severed between the transmission towers, with the middle and high wires remaining intact.

On the east residence property, adjacent to the wall, were two bare trees spaced about 37 feet apart. Numerous branches on both trees had been broken, with signatures consistent with being recently detached from their respective tree.

The main wreckage consisted of the fuselage, right wing, vertical stabilizer (with rudder affixed), and right horizontal stabilizer (with elevator affixed). Numerous people at the accident site noted that around the area of the main wreckage was a pronounced odor consistent with that of 100LL aviation gasoline.

The entire wreckage was positioned with the right side higher consistent with the airplane attitude in a 35-degree left bank. The instrument panel and fuselage forward of the front seats sustained aft crush deformation and were fragmen

Aircraft

Registration
N3144D
Reported as
Beech B36TC
Category
Airplane
Serial number
EA-472
Airframe hours
3,074
Engine
Teledyne Continental TSIO-520-UB12, 300 horsepower, reciprocating
Damage
Substantial damage
Flight
Personal · Part 91
Airworthiness certificate
Standard, Normal; Standard, Utility
Last inspection
Annual · September 1, 2006 · 31 hours before
Departed
O85 · Redding, CA
Destination
FUL · Fullerton, CA
Flight plan
IFR
Airport
FUL · Fullerton Municipal Airport, runway 06, 3,121 × 75 ft, asphalt

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
51
Injuries
Serious
Certificate
Private
Airplane ratings
Single-engine land
Instrument ratings
Airplane
Medical
Class 3, With waivers/limitations
Last flight review
January 1, 2006
Seat
Left
Flight hours
2,138 total · 750 in this make and model · 2,100 as pilot in command · 29 in the last 90 days · 8 in the last 30 days · 3 in the last 24 hours

Weather

Conditions
Visual (VMC) · Night
Wind
200° at 5 knots
Visibility
10 statute miles
Lowest ceiling
None
Temperature
61 °F, dew point 48 °F
Altimeter
29.95 inHg
Observed at
FUL

FAA reports on this event · 1

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