# NTSB LAX91FA282: Beech 65, N713JB, Pioneer, CA, June 30, 1991

- Type: NTSB accident investigation
- Classification: Accident · Fatal · Field investigation · Final report
- Date: June 30, 1991, 09:11 local (16:11 UTC)
- Place: Pioneer, CA
- Coordinates: 38.519603, -120.38092 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=38.5196&lon=-120.3809&mi=10
- Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping)
- Highest injury: Fatal
- Injuries: 6 fatal
- Status: Completed, report June 2, 1992
- Report: Approved by Office Director
- NTSB case key (mKey): 27011
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX91FA282
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/27011/pdf
- Page: https://openairdocs.org/ntsb/LAX91FA282

## 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

In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf).

- Loss of engine power(partial) - mech failure/malf, cruise
  - 1 engine
  - engine assembly,valve,exhaust - fatigue (contributing factor)
  - maintenance,installation - improper, other maintenance personnel (contributing factor)
- Forced landing, descent - emergency
  - emergency procedure - improper, pilot in command (cause)
  - wrong propeller feathered - inadvertent, pilot in command (cause)
  - lack of familiarity with aircraft, pilot in command (contributing factor)
- In flight collision with object, landing - flare/touchdown
  - object - tree(s)
- In flight collision with terrain/water, landing
  - 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](https://openairdocs.org/deregistered/N713JB-1992-08-24), registration cancelled 1992-08-24, S/N LC35 (OpenAirDocs)
- Reported make and model: BEECH 65
- Registry model: [Beech 65](https://openairdocs.org/model/beech-65) (registry code 1152802) (OpenAirDocs)
- Category: Airplane
- Serial number: LC-35
- Airframe hours: 4958
- Engines: 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

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 47; 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 (OpenAirDocs).

- [Accident 19910630024879A](https://openairdocs.org/incident/19910630024879A), Jun 30, 1991: Beech 65, Pioneer, CA, Destroyed, 6 fatal. Spun into trees after right engine failure. Improperly seated valve seat caused internal damage. Pilot lost control

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.

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