# NTSB NYC91LA224: Cessna 337, N6304F, Urbana, OH, August 27, 1991 - Type: NTSB accident investigation - Classification: Accident · Minor injuries · Limited investigation · Final report - Date: August 27, 1991, 14:10 local (18:10 UTC) - Place: Urbana, OH - Location: 40.1081° N, 83.7554° W: Placed by OpenAirDocs: center of Urbana, OH, within about 6 miles (OpenAirDocs) - Nearby events: https://openairdocs.org/map.md?lat=40.1081&lon=-83.7554&mi=10 - Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping) - Highest injury: Minor injuries - Injuries: 1 minor - Status: Completed, report April 23, 1993 - Report: Approved by Office Director - NTSB case key (mKey): 37001 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=NYC91LA224 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/37001/pdf - Page: https://openairdocs.org/ntsb/NYC91LA224 ## Probable cause THE PILOT'S FAILURE TO FOLLOW PROCEDURES AND DIRECTIVES WHICH RESULTED IN THE FAILURE OF THE PILOT TO RECOGNIZE THE STOPPAGE OF THE REAR ENGINE PRIOR TO TAKE OFF. ADDITIONALLY THE LACK OF TOTAL ENGINE POWER RESULTED IN THE INABILITY OF THE PILOT TO MAINTAIN THE PROPER CLIMB SPEED, AND RESULTED IN A SUBSEQUENT FORCED LANDING IN WATER. FACTORS RELATED TO THE ACCIDENT WERE THE PILOT'S FAILURE TO COMPLY WITH THE MANUFACTURER'S SERVICE LETTER PERTAINING TO THE OPERATIONAL PROCEDURES TO PREVENT A REAR ENGINE POWER LOSS, AND THE PILOT'S TOTAL LACK OF FLYING EXPERIENCE IN THIS TYPE OF AIRPLANE. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of engine power(partial) - nonmechanical, takeoff - initial climb - powerplant - failure,total (cause) - procedures/directives - not followed, pilot in command (cause) - lack of total experience in type of aircraft, pilot in command (cause) - stall/mush - encountered, pilot in command (cause) - procedure inadequate, pilot in command - Forced landing, descent - emergency - terrain condition - water (cause) ## Analysis THE PILOT'S PREFLIGHT CONSISTED OF CHECKING THE FUEL TANKS WITH A STICK, AND FINDING ABOUT 2 INCHES OF FUEL IN THE RIGHT MAIN FUEL TANK. THE AIRPLANE HAD JUST COME OUT OF MAINTENANCE BECAUSE OF INOPERATIVE FUEL GAUGES. THE PILOT WAS RETURNING TO HIS HOME AIRPORT, LANDED AND INTENDED TO TAKEOFF AGAIN. BECAUSE OF WINDS HE HAD TO TAXI TO A DIFFERENT RUNWAY. JUST AFTER TAKEOFF AND AT A LOW ALTITUDE THE PILOT REALIZED THE REAR ENGINE HAD FAILED. THE AIRPLANE STARTED TO STALL, HOWEVER THE PILOT SAID THERE WAS NOT ENOUGH RUNWAY REMAINING TO ABORT THE TAKE OFF. HE ELECTED TO MAKE A FORCED LANDING AND CAME TO REST IN A POND. THE FUEL SELECTOR FOR THE REAR ENGINE WAS FOUND ON THE RIGHT MAIN TANK. A CESSNA SERVICE LETTER AND AD HAD BEEN ISSUED FOR THIS TYPE AIRPLANE CALLING FOR AN OPERATIONAL PROCEDURE; TO LEAD WITH THE REAR ENGINE WHILE TAXIING, AND DURING TAKE OFF, IN ORDER TO MORE CLEARLY RECOGNIZE A REAR ENGINE FAILURE. THE PILOT'S STATEMENT DID NOT INDICATE THAT HE HAD COMPLIED WITH EITHER THE SERVICE LETTER OR THE AD. ## Aircraft - Registration: [N6304F](https://openairdocs.org/deregistered/N6304F-2013-04-29), registration cancelled 2013-04-29, S/N 337-0304, built 1966 (OpenAirDocs) - Reported make and model: CESSNA 337 - Registry model: [Cessna 337A](https://openairdocs.org/model/cessna-337a) (registry code 2075704) (OpenAirDocs) - Registry engine: [Continental IO-360 series](https://openairdocs.org/engine/continental-io-360-series) (registry code 17025, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 0304 - Engines: CONTINENTAL IO-360-C 210 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Martin J. Cook - Registered owner: Martin J. Cook - Airworthiness certificate: Standard, Normal - Last inspection: Unknown, January 2, 2000 - Departed: VFY, LONDON, OH - Airport: I74, Grimes Field, runway 23, 3,500 × 75 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 74; commercial; airplane ratings: multi-engine land, single-engine land; instrument ratings: airplane; medical: class 3, valid medical--w/ waivers/lim; seat: left; flight hours: 4,000 total, 4,000 as pilot in command, 21 in the last 90 days, 2 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: variable at 5 knots - Visibility: 10 statute miles - Temperature: 81 °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 19910827036819A](https://openairdocs.org/incident/19910827036819A), Aug 27, 1991: Cessna 337, Urbana, OH, Substantial damage. Lost rear engine on initial takeoff unknown until climbout. Settled into ground impact. Rear engine on empty tank. ## Other investigations on N6304F (1) 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. - [NTSB CHI77DEP64](https://openairdocs.org/ntsb/CHI77DEP64), Sep 28, 1977: Cessna 337 (N6304F), Wilmot, WI, substantial damage 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. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.