LAX91FA282

NTSB accident investigation · Beech 65 · Pioneer, CA · June 30, 1991

Accident · FatalField investigationFinal report
Date
June 30, 1991, 09:11 local (16:11 UTC)
Place
Pioneer, CA
Injuries
6 fatal
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N713JBBeech 65
Weather
Visual (VMC) · Day
Status
Completed · report June 2, 1992
Report
Approved by Office Director
FAA report
19910630024879A
Case key
27011

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

Improper emergency procedures by the pilot, when he inadvertently shut down the left engine after encountering a partial loss of power in the right engine. Factors related to the accident were: improper installation of the right engine's #6 exhaust valve seat by other maintenance personnel, fatigue failure of the #6 exhaust valve, and the pilot's lack of familiarity with the aircraft.

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 power(partial) - mech failure/malfCruise
1 engine
Engine assembly,valve,exhaust - fatigueFactor
Maintenance,installation - improperOther maintenance personnelFactor
Forced landingDescent - emergency
Emergency procedure - improperPilot in commandCause
Wrong propeller feathered - inadvertentPilot in commandCause
Lack of familiarity with aircraftPilot in commandFactor
In flight collision with objectLanding - flare/touchdown
Object - tree(s)
In flight collision with terrain/waterLanding
Terrain condition - mountainous/hilly

Analysis

A Beech 65 collided with trees in mountainous terrain after an inflt loss of control. A pilot observed the airplane start a turn to the right, roll right and continued until inverted and enter into a spin. The acft was in a steep nose down attitude when it began its pull; out. The engines were heard by a ground witness who initially mistook them for an approach motorcycle. The pilot initially flew the acft 45 days before the accident and logged 3.5 dual instruction hours. There was no record in the pilot's logbook of any additional flt trng since the initial flt. The plt satisfactorily completed a bfr in a Cessna 150 four days before the accident. Exam of the wreckage dsclsd the rt eng had broken exhaust valve, but the left prop was feathered. There were no preexisting mech malfunctions or failures found with the left eng.

Aircraft

Registration
N713JB
Reported as
Beech 65
Category
Airplane
Serial number
LC-35
Airframe hours
4,958
Engine
Lycoming IGSO-480-A16A, 340 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Personal · Part 91
Registered owner
Stahl, Richard E.
Airworthiness certificate
Standard, Normal
Last inspection
Annual · January 6, 1990 · 39 hours before
Departed
MOD · Modesto, CA
Destination
TVL · S Lake Tahoe, CA

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
47
Certificate
Commercial
Airplane ratings
Multi-engine land, Single-engine land
Instrument ratings
Airplane
Medical
Class 2, Valid Medical--w/ waivers/lim
Seat
Left
Toxicology
Performed
Flight hours
2,830 total · 27 in this make and model · 24 in the last 90 days · 12 in the last 30 days · 1 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Visibility
30 statute miles
Lowest ceiling
None
Temperature
70 °F, dew point -0 °F

FAA reports on this event · 1

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