# NTSB NYC99LA223: Beech A23, N3508R, Carlisle, PA, September 12, 1999 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: September 12, 1999, 17:10 local (21:10 UTC) - Place: Carlisle, PA - Coordinates: 40.19952, -77.200477 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=40.1995&lon=-77.2005&mi=10 - Phase of flight: [Approach](https://openairdocs.org/ntsb-phases/500) (OpenAirDocs' grouping) - Highest injury: No injuries - Injuries: 2 uninjured - Status: Completed, report November 22, 2000 - Report: Approved by Office Director - NTSB case key (mKey): 47360 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=NYC99LA223 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/47360/pdf - Page: https://openairdocs.org/ntsb/NYC99LA223 ## Probable cause The pilot's improper fuel management, resulting in fuel starvation. ## Sequence of events In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf). - Loss of engine power(total) - nonmechanical, approach - vfr pattern - final approach - fluid,fuel - starvation - fuel management - improper, pilot in command (cause) - In flight collision with terrain/water, descent - uncontrolled ## Analysis While on final approach, the engine lost all power, and the pilot performed a forced landing to a field. The pilot stated that after the landing, he moved the fuel selector from 'LEFT' to 'OFF'. Examination of the wreckage by a Federal Aviation Administration (FAA) Inspector did not reveal any pre-impact mechanical malfunctions. The inspector observed approximately 18 gallons of fuel in the right fuel tank. He did not observe any fuel in the left fuel tank. According to FAA records, on April 7, 1998, a Continental IO-346A was removed from the airplane; and a Lycoming IO-360 was installed. According to an engineering report from General Aviation Technical Services, Inc., the Lycoming engine burned more fuel per hour than the Continental engine. The pilot reported 16.7 hours of total flight experience in the accident airplane. ## Factual narrative On September 12, 1999, about 1710 Eastern Daylight Time, a Beech A23, N3508R, was substantially damaged during a forced landing at Carlisle, Pennsylvania. The certificated private pilot and passenger were not injured. Visual meteorological conditions prevailed for the flight that originated from Wilkes-Barre Wyoming Valley Airport, Wilkes-Barre, Pennsylvania; destined for Carlisle Airport (N94), Carlisle, Pennsylvania. No flight plan was filed for the personal flight conducted under 14 CFR Part 91. The pilot stated that he flew a visual approach to Runway 28 at N94. Due to traffic on the runway, he performed a go-around. During the go-around, the engine "...sputtered, but kept running." He then flew a normal traffic pattern to the same runway. On final approach, the engine lost all power, and the pilot performed a forced landing to a field, short of Runway 28. During the landing, the nose gear, left wing, and right wing sustained substantial damage. The pilot stated that after the landing, he moved the fuel selector from "LEFT" to "OFF". Before the flight, 9 gallons of fuel was added to the left tank. The pilot estimated that he had between 15-20 gallons of fuel in the left tank. However, he stated that the first half of the flight was flown with the fuel selector on "RIGHT". Examination of the wreckage by a Federal Aviation Administration (FAA) Inspector did not reveal any pre-impact mechanical malfunctions. The inspector observed approximately 18 gallons of fuel in the right fuel tank. He did not observe any fuel in the left fuel tank. He added that the left fuel tank was not compromised during the accident, nor did he observe any evidence of fuel leaks. According to FAA records, on April 7, 1998, a Continental IO-346A was removed from the airplane; and a Lycoming IO-360 was installed. According to an engineering report from General Aviation Technical Services, Inc.: "The Lycoming IO-360-A2B develops 35 more horsepower at take-off. Using a conservative SFC of .7 lb/hp/hr at full rich, the Continental engine would use approximately 19 GPH at T.O. and the Lycoming will consume 23 GPH at T.O." The pilot reported a total flight experience of 177.6 hours, of which, 16.8 hours were in the accident airplane. ## Aircraft - Registration: [N3508R](https://openairdocs.org/deregistered/N3508R-2002-05-23), registration cancelled 2002-05-23, S/N M-664, built 1965 (OpenAirDocs) - Reported make and model: Beech A23 - Registry model: [Beech A23](https://openairdocs.org/model/beech-a23) (registry code 1151204) (OpenAirDocs) - Registry engine: [Continental IO-346 series](https://openairdocs.org/engine/continental-io-346-series) (registry code 17033, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: M-664 - Airframe hours: 2300 - Engines: Lycoming IO-360 200 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Joseph T. Gembusia - Registered owner: Bryan Gembusia - Airworthiness certificate: Standard, Normal - Last inspection: Annual, February 20, 1999, 50 hours before - Departed: WBW, WILKES-BARRE, PA - Destination: N94 - Airport: N94, Carlisle Airport, runway 28, 4,008 × 40 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 54; private; airplane ratings: single-engine land; medical: class 3, valid medical--w/ waivers/lim; seat: left; flight hours: 178 total, 17 in this make and model, 17 in the last 90 days, 7 in the last 30 days, 2 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 180° at 7 knots - Visibility: 20 statute miles - Lowest ceiling: none - Temperature: 81 °F, dew point 52 °F - Altimeter: 30.00 inHg - Observed at: KCX, 17 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 19990912044559A](https://openairdocs.org/incident/19990912044559A), Sep 12, 1999: Beech A23, Carlisle, PA, No damage. (-23)Aircraft engine quit due to fuel depletion in left main tank. Aircraft crashed in a small open area near the airport. Pilot failed to manage available… 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.