- Date
- March 15, 1990, 22:45 local (Mar 16, 1990, 03:45 UTC)
- Place
- Lake Butler, FL
- Injuries
- 1 minor
- Damage
- Destroyed
- Phase of flight
- Enroute
- Aircraft
- N7443SButler Aerostar 601
- Weather
- Visual (VMC) · Night/dark
- Status
- Completed · report September 10, 1992
- Report
- Approved by Office Director
- FAA report
- 19900315004499A
- Case key
- 32552
From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the accident.
On this page
Probable cause
Inflight failure of the left engine which was caused by inadequate maintenance and inspection by company maintenance personnel resulting in heat damaged magneto leads as a result of a missing exhaust flange-to-turbocharger seal. In addition, the inflight power loss of the right engine was caused by the pilot's failure to follow the procedures in the airplane operating handbook and land as soon as possible resulting in fuel starvation of the right engine. Darkness was a related factor.
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.
Analysis
Shortly after leveling off at 14,000 ft the left engine quit. The pilot diverted to tampa, and 34 minutes later the right engine quit. During the subsequent forced landing the airplane collided with the roof of a covered sidewalk and then trees. Teardown of the left eng revealed that the seal between the exhaust flange & turbocharger was not installed; bolt clamp was finger tight. Heat had melted wiring harness & mag grounding leads insulation; both 'p' leads were grounded. Pilot stated that after losing the left eng he initiated a left tank to right engine crossfeed, and after 20 minutes of single eng flight in this configuration the right eng quit. Flight manual states to land as soon as possible in case of one eng failure. In addition, it warns that when flying on one eng & crossfeeding fuel, absolute coordinated flight must be maintained to prevent unporting of the tank's fuel pickup tube when the tank is not full.
Aircraft
- Registration
- N7443S
- Reported as
- Butler Aerostar 601 (AEROSTAR 6)
- Category
- Airplane
- Serial number
- 61-0063
- Airframe hours
- 3,234
- Engine
- Lycoming IO-540-AA1A5, 290 horsepower, reciprocating
- Damage
- Destroyed
- Flight
- Part 135
- Registered owner
- Top Flight Air Service
- Airworthiness certificate
- Standard, Normal
- Last inspection
- AAIP · February 7, 1990 · 42 hours before
- Departed
- CRG · Jacksonville, FL
- Destination
- Atlanta, GA
- Flight plan
- IFR
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
- 26
- Certificates
- Commercial, Airline transport
- Airplane ratings
- Multi-engine land, Single-engine land
- Instrument ratings
- Airplane
- Medical
- Class 1, Valid Medical--no waivers/lim.
- Seat
- Left
- Flight hours
- 4,548 total · 2,024 in this make and model · 3,835 as pilot in command · 350 in the last 90 days · 109 in the last 30 days · 5 in the last 24 hours
Weather
- Conditions
- Visual (VMC) · Night/dark
- Wind
- 120° at 4 knots
- Visibility
- 7 statute miles
- Lowest ceiling
- None
- Temperature
- 70 °F, dew point 57 °F
- Altimeter
- 30.00 inHg
- Observed at
- GNV, 29 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.