# NTSB LAX91LA118: Beech BE-77, N3846X, Carmel Valley, CA, March 2, 1991

- Type: NTSB accident investigation
- Classification: Accident · Serious injuries · Limited investigation · Final report
- Date: March 2, 1991, 12:56 local (20:56 UTC)
- Place: Carmel Valley, CA
- Coordinates: 36.389255, -121.650001 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=36.3893&lon=-121.6500&mi=10
- Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping)
- Highest injury: Serious injuries
- Injuries: 1 serious, 1 minor
- Status: Completed, report January 25, 1993
- Report: Approved by Office Director
- NTSB case key (mKey): 27125
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX91LA118
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/27125/pdf
- Page: https://openairdocs.org/ntsb/LAX91LA118

## Probable cause

THE FAILURE OF THE PIC TO SUPERVISE A NON-CERTIFICATED PILOT AND TO MAINTAIN ADEQUATE AIRSPEED WITH SUBSEQUENT COLLISION WITH TREES. CONTRIBUTING TO THE ACCIDENT WAS THE FAILURE OF THE PIC TO OBTAIN A WEATHER BRIEFING AND ASSESS HAZARDOUS WIND CONDITIONS AND OVERCONFIDENCE IN THE PILOT'S ABILITY TO DEAL WITH THE WEATHER AND AIRPLANE PERFORMANCE ISSUES.

## Sequence of events

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

- In flight encounter with weather, takeoff - initial climb
  - weather condition - windshear (contributing factor)
  - supervision - not maintained, pilot in command (cause)
  - overconfidence in personal ability, pilot in command (contributing factor)
  - planning/decision - poor, pilot in command (contributing factor)
  - overconfidence in aircraft's ability, pilot in command (contributing factor)
  - hazardous weather advisory - not obtained, pilot in command (contributing factor)
- Loss of control - in flight, maneuvering
  - airspeed(vs) - not maintained, pilot in command (cause)
- In flight collision with terrain/water, descent - uncontrolled
  - object - tree(s)

## Analysis

THE CERTIFICATED COMMERCIAL PILOT AND A NON-CERTIFICATED PASSENGER, BOTH CO-OWNERS OF THE AIRPLANE, DEPARTED THE AIRPORT WITH THE PASSENGER AT THE CONTROLS.  AFTER TAKEOFF, THE AIRPLANE ENCOUNTERED TURBULENCE, GUSTY WINDS AND WIND SHEAR AND WAS UNABLE TO CLIMB OVER ABOUT 300 FEET ABOVE GROUND LEVEL.  THE PILOT-IN-COMMAND TOOK OVER THE CONTROLS AND BEGAN MANEUVERING THE AIRPLANE TO AVOID RISING TERRAIN AND ATTEMPTED TO GAIN OROGRAPHIC LIFT FROM SURROUNDING HILLS. WITH THE STALL WARNING SOUNDING, THE AIRPLANE STRUCK A TREE ON A RIDGE LINE ABOUT 1 MILE FROM THE AIRPORT.  THE AIRPLANE THEN DESCENDED THROUGH SEVERAL OTHER TREES AND WAS DESTROYED.  A SIGMET WAS IN EFFECT FOR LOW LEVEL WIND SHEAR.

## Aircraft

- Registration: [N3846X](https://openairdocs.org/deregistered/N3846X-1991-07-08), registration cancelled 1991-07-08, S/N WA243 (OpenAirDocs)
- Reported make and model: Beech BE-77
- Registry model: [Beech 77](https://openairdocs.org/model/beech-77) (registry code 1153007) (OpenAirDocs)
- Category: Airplane
- Serial number: WA-243
- Airframe hours: 2445
- Engines: LYCOMING O-235-L2C 115 horsepower reciprocating
- Damage: Destroyed
- Flight: Personal, Part 91
- Operator: Burford A. Carlson
- Registered owner: Burford A. Carlson
- Airworthiness certificate: Standard, Normal
- Last inspection: Annual, August 10, 1990, 92 hours before
- Departed: 062, CARMEL VALLEY, CA
- Destination: SNS, SALINAS, CA

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 61; commercial; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 2, valid medical--w/ waivers/lim; seat: right; flight hours: 5,661 total, 51 in this make and model, 3,200 as pilot in command, 19 in the last 90 days, 4 in the last 30 days, 0.1 in the last 24 hours

## Weather

- Conditions: Visual (VMC), Day
- Wind: 180° at 10 knots
- Visibility: 20 statute miles
- Lowest ceiling: 10,000 ft broken
- Temperature: 66 °F, dew point 43 °F
- Altimeter: 30.00 inHg
- Observed at: MRY, 9 nm away

## 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 19910302003699A](https://openairdocs.org/incident/19910302003699A), Mar 2, 1991: Beech 77, Carmel Valley, CA, Destroyed. Departed into rising terrain and severe turbulence. Unable to climb, struck trees. SIGMET in effect for windshear.

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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