NYC03LA075

NTSB accident investigation · Beech B-60 · Bradford, PA · March 31, 2003

Accident · Serious injuriesLimited investigationFinal report
Date
March 31, 2003, 13:12 local (18:12 UTC)
Place
Bradford, PA
Injuries
1 serious
Damage
Destroyed
Phase of flight
Enroute
Aircraft
N215CQBeech B-60
Weather
Instrument (IMC) · Day
Status
Completed · report September 1, 2004
Report
Approved by Office Director
Parties
Raytheon, Textron Lycoming, Federal Aviation Administration
FAA report
20030331012929A
Case key
56722

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

The pilot's improper decision to maneuver for a landing in a configuration that exceeded the capability of the airplane to maintain altitude, after he lost power on one engine for undetermined reason(s).

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 powerCruise - normal
1 engineCause
Reason for occurrence undeterminedCause
Loss of control - in flightManeuvering - turn to landing area (emergency)
Aircraft performance,engine out capability - exceededCause
In-flight planning/decision - improperPilot in commandCause
In flight collision with objectDescent - uncontrolled
Object - tree(s)

Analysis

The pilot first reported that the engine oil temperature had dropped below what he normally observed while en route. When he tired to exercise the left propeller control, and then later tried to feather the left engine, he was unable to change the engine rpm. He then heard a pop from the right engine, and advised air traffic control (ATC), he needed to perform a landing at Bradford. He also reported a double power loss. While being radar vectored for the ILS runway 32 approach, he told ATC he was getting some power back. He was radar vectored inside of the outer marker, and broke out mid-field and high. At the departure end of the runway, he executed a right turn and during the turn, the airplane descended into trees, and a post crash fire destroyed it. A witness reported he heard backfiring when the airplane over flew the runway. When the airplane was examined, the landing gear was found down, and the wing flaps were extended 15 degrees. Neither propeller was feathered. Both engines were test run and performed satisfactorily. The left engine fuel servo was used on the right engine due to impact damage on the right engine fuel servo. The right fuel servo was examined and found to run rich. However, no problems were found that would explain a power loss, prevent the engine from running, or explain the backfiring heard by a witness. Both propellers were examined and found to be satisfactory, with an indication of more power on the left propeller than on the right propeller. The weather observation taken at 1253 included a ceiling of 1,100 feet broken, visibility 1 mile, light snow and mist. The weather observation taken at 1310 included a ceiling of 900 feet broken, visibility 3/4 mile, and light snow and mist. According to the pilot's handbook, the airplane could maintain altitude or climb on one engine, but it required the propeller to be feathered, and the landing gear and wing flaps retracted.

Factual narrative

On March 31, 2003, at 1312 eastern standard time, a Beech B-60, N215CQ, was destroyed during a forced landing at Bradford Regional Airport (BFD), Bradford, Pennsylvania. The certificated private pilot received serious injuries. Instrument meteorological conditions prevailed for the business flight that departed from Long Island MacArthur Airport, Islip, New York, and was destined for Gary, Indiana. An instrument flight rules (IFR) flight plan had been filed for the flight that was conducted under 14 CFR Part 91.

The pilot reported that his planned final destination was Cheyenne, Wyoming, with an en route fuel stop at Gary, Indiana. He had departed Islip at 1109, with the fuel filled to capacity, 231 gallons.

The final cruise altitude was 16,000 feet. The pilot reported that the airplane was passing in and out of the tops of the clouds, with the airplane more out of the weather than in it. He observed a drop in the engine oil temperature on both engines to about 50 C or maybe cooler. This was lower than he had normally observed, but the engine oil temperatures were still in the green. He also observed a drop in the outside air temperature from -20 C to -40 C, and the left engine was starting to vibrate.

At 1225, control of the flight was passed to Crosby Radar Section of the Cleveland Air Route Traffic Center (ARTCC).

At 1247, the pilot requested to divert to Erie, Pennsylvania, and added that he may have a problem. The pilot was cleared direct to Erie.

At 1251, the pilot said he had to go to Erie, and he had a problem. He then request the Erie weather and it was given to him.

At 1252, the pilot reported that he was going to shut down his left engine, and he subsequently declared and emergency. About four minutes later, the controller observed the airplane had taken a southwestly heading and advised the pilot. The pilot reported that he was trying to get things under control. At 1258, in response to a question from the controller, the pilot reported that he had his hands full.

At 1302, the pilot requested a closer airport with good weather, and was told that Bradford was located 5 miles away. The pilot requested and received the Bradford weather, and in addition was given the runway information for Bradford.

At 1304:10, the pilot transmitted, " ...we need Bradford now." The pilot was given a descent clearance to 4,000 feet, and requested the approach frequencies which were given to him.

At 1304:29, the pilot reported that he had a double engine failure. He continued to receive radar vectors for the approach to Bradford.

At 1307;41, the pilot requested to be radar vectored inside the outer marker, and controller replied that he was doing that.

At 1308:30, the pilot reported that he just got some engine power back.

The approach controller continued to respond to all of the pilots requests for weather, airport elevation, runway length, and other information.

The last transmission received from the airplane was at 1310:57, when the pilot stated:

"I need the field elevation now."

The airplane was next observed by two witnesses on the airport. They saw the airplane fly over and heard a backfiring sound. The airplane turned to the right, after which it disappeared from view. They then saw black smoke rising from the area where the airplane disappeared from view. They traveled to the area, and saw a man walking toward them.

When interviewed after the accident, the pilot reported multiple occurrences with the airplane. He added that the decision to divert to Erie, Pennsylvania was made after he observed a decrease in engine oil temperature. He increased power, but the engine oil temperature did not change; however, he added that he may not have left the increased power on long enough to make a difference in the engine oil temperature. He then moved the left propeller control and tried to increase engine rpm. However, although the propeller control moved, there was no change of rpm with the engine. The turbocharger turbine inlet temperature (TIT) had decreased down to about 1,000 F. He added that normally he flies with the TIT about 1,580 F.

When he looked at the fuel flow totalizer for both engines, he saw it was reading 20.9 gph on the right engine, and zero fuel flow on the left engine. He then tried to feather the left engine; however, it would not feather. The right engine appeared to be operating normally. The pilot then heard what he perceived was a "pop" from the right engine. Shortly thereafter reported that he had experienced a double power loss.

The pilot did not recall the altitude of the airplane as it descended out of the clouds, but said the airplane was midfield and low. He could see the departure end of the runway ahead, and as he passed over the departure end of the runway, he initiated a right turn of 180 degrees. During the turn, the airplane continued to descend and he leveled the wings and let the airplane settle into an area of small trees. A post crash fire developed, and consumed the fuselage.

The airplane and engines were examined by representatives of Raytheon Aircraft, and Textron Lycoming, under the supervision of an airworthiness inspector from the Federal Aviation Administration (FAA). The airplane impacted in a wooded area on the airport property. The accident site was located about 900 feet north of the approach end of runway 14, and abeam of the 1,000 foot marker on the runway. Trees at the accident site were broken, consistent with a 30 degree right bank as the airplane entered the trees. The debris trail was on a heading of 120 degrees magnetic for about 200 feet. Both engines had separated from the airframe during the impact sequence. The fuselage was destroyed by fire. The landing gear was found extended, and the wing flaps were extended to 15 degrees.

Both engines were run at Textron Lycoming under the supervision of an FAA airworthiness inspector. The left engine ran with no problems noted. The right engine fuel servo had sustained impact damage and could not be used in an engine run. The fuel servo from the left engine was removed and placed on the right engine. The right engine ran with no problems noted.

The right engine fuel servo was examined at Precision Aeromotive under the supervision of an FAA airworthiness inspector. The unit was found to run richer than the maximum specified. In all tests, the richness exceeded the maximum allowed by 5 to 10 percent at higher air flows. The FAA inspector added that nothing was found with the fuel servo that would explain a power loss, prevent the engine from running, or explain the backfiring heard by a witness.

Both propellers were examined at Hartzell Propellers, under the supervision of an FAA airworthiness inspector. The report stated:

"...Both propellers were rotating at the time of impact. The amount of power could not be determined, but the # 1 (right engine) propeller appeared to have less power than the # 2 (Left engine) propeller."

"There were no discrepancies noted that would preclude normal operation. All damage was consistent with impact damage...."

According to data from the FAA, runway 14/32 was 6,499 feet long, 150 feet wide, and had a grooved asphalt surface. Runway 14 was also served by a 4 box VASI with a 3 degree glide path. High intensity runway edge lights were installed.

The 1253 weather observation at Bradford, the last observation prior to the accident, recorded in part: winds from 260 degrees at 6 knots, visibility 1 statute mile, light snow and mist, ceiling 1,100 feet broken, 1,500 feet overcast, temperature -4 C, dewpoint -6 C, and altimeter 29.89.

The 1310 weather observation at Bradford, about 1 minute after the accident, recorded in part: winds from 240 degrees at 10 knots with gusts to 14 knots, visibility 3/4 statute mile, light snow and mist, ceiling 900 broken, 1,500 feet overcast, temperature -4 C, de

Aircraft

Registration
N215CQ
Reported as
Beech B-60
Category
Airplane
Serial number
P-458
Airframe hours
5,217
Engines
Textron Lycoming TIO-541-E1C4, 380 horsepower, reciprocatingTextron Lycoming Tio-541-E1C4, 380 horsepower, reciprocating
Damage
Destroyed
Fire
On-Ground
Flight
Business · Part 91
Airworthiness certificate
Standard, Normal
Last inspection
Annual · November 25, 2002 · 94 hours before
Departed
ISP · Islip, NY
Destination
GVY · Gary, IN
Flight plan
IFR
Airport
BFD · Bradford Regional Airport, runway 14, 6,499 × 150 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
59
Injuries
Serious
Certificate
Private
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 3, Valid Medical--w/ waivers/lim
Last flight review
February 18, 2002
Seat
Left
Flight hours
4,580 total · 1,318 in this make and model · 4,000 as pilot in command · 53 in the last 90 days · 20 in the last 30 days

Weather

Conditions
Instrument (IMC) · Day
Wind
260° at 6 knots
Visibility
1 statute miles
Lowest ceiling
1,100 ft broken
Temperature
25 °F, dew point 21 °F
Altimeter
29.88 inHg
Observed at
BFD

FAA reports on this event · 1

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