# NTSB SEA08LA191: Cessna 172N, N172ST, Burbank, CA, August 30, 2008 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: August 29, 2008, 18:56 local (Aug 30, 2008, 01:56 UTC) - Place: Burbank, CA - Coordinates: 34.204723, -118.362777 - Nearby events: https://openairdocs.org/map.md?lat=34.2047&lon=-118.3628&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute-cruise: Fuel exhaustion](https://openairdocs.org/ntsb-events/192) - Highest injury: Serious injuries - Injuries: 1 serious, 2 minor - Status: Completed, report January 29, 2009 - Report: Approved by Office Director - Parties: Federal Aviation Administration - NTSB case key (mKey): 68832 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=SEA08LA191 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/68832/pdf - Page: https://openairdocs.org/ntsb/SEA08LA191 ## Probable cause The pilot's improper preflight and in-flight planning, which resulted in fuel exhaustion. Contributing to the accident were the pilot's loss of situational awareness while conducting the normal and emergency checklists during his turn from base to final approach, and the dark night condition. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Info processing/decision: decision making/judgment](https://openairdocs.org/ntsb-findings/02041520): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Cessna 172N, 41 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md?model=2072434), [All aircraft, 3,098 cases](https://openairdocs.org/ntsb-findings/02041520/cases.md) - [Planning/preparation: fuel planning](https://openairdocs.org/ntsb-findings/02061030): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Cessna 172N, 5 cases](https://openairdocs.org/ntsb-findings/02061030/cases.md?model=2072434), [All aircraft, 719 cases](https://openairdocs.org/ntsb-findings/02061030/cases.md) - [Fluids: fuel](https://openairdocs.org/ntsb-findings/01071010): Aircraft › Fluids/misc hardware · Fluid level (probable cause); cases with it: [Cessna 172N, 8 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md?model=2072434), [All aircraft, 1,695 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md) - [Perception/orientation/illusion: situational awareness](https://openairdocs.org/ntsb-findings/02022035): Personnel issues › Psychological · Pilot (probable cause); cases with it: [Cessna 172N, 2 cases](https://openairdocs.org/ntsb-findings/02022035/cases.md?model=2072434), [All aircraft, 111 cases](https://openairdocs.org/ntsb-findings/02022035/cases.md) - [Light condition: dark](https://openairdocs.org/ntsb-findings/03036020): Environmental issues › Conditions/weather/phenomena · Effect on operation (probable cause); cases with it: [Cessna 172N, 4 cases](https://openairdocs.org/ntsb-findings/03036020/cases.md?model=2072434), [All aircraft, 448 cases](https://openairdocs.org/ntsb-findings/03036020/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute-cruise: Fuel exhaustion](https://openairdocs.org/ntsb-events/192) (defining event); cases with it: [Cessna 172N, 5 cases](https://openairdocs.org/ntsb-events/192/sequence.md?model=2072434), [All aircraft, 804 cases](https://openairdocs.org/ntsb-events/192/sequence.md) - [Emergency descent: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341); cases with it: [Cessna 172N, 28 cases](https://openairdocs.org/ntsb-events/341/sequence.md?model=2072434), [All aircraft, 3,820 cases](https://openairdocs.org/ntsb-events/341/sequence.md) - [Maneuvering: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Cessna 172N, 31 cases](https://openairdocs.org/ntsb-events/440/sequence.md?model=2072434), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) - [Maneuvering: Controlled flight into terr/obj (CFIT)](https://openairdocs.org/ntsb-events/120); cases with it: [Cessna 172N, 14 cases](https://openairdocs.org/ntsb-events/120/sequence.md?model=2072434), [All aircraft, 1,074 cases](https://openairdocs.org/ntsb-events/120/sequence.md) ## Analysis The pilot departed on the two-leg, round robin cross-country flight with 40 gallons of fuel on board, having been trained to use 8 to 10 gallons per hour (gph) for flight planning purposes. The pilot flight and fuel planned for the first leg of the flight; however, he did not flight or fuel plan for the return second leg. The first leg of the 286 nautical mile flight was planned for an average ground speed of 98 knots and an average fuel burn of 8 gph. The flight took 2.8 hours, consumed 24.7 gallons of fuel, and landed with 15.3 gallons of fuel remaining. Prior to departing on the return leg the pilot added 10 gallons of fuel, for a total of 25.3 gallons, which equates to an endurance of 2.8 hours at an average fuel burn of 9 gph. By regulation, the pilot should have had a minimum of 32 gallons fuel on board; 25 gallons for the en route portion and 7 gallons reserve. About 35 nm from the destination airport the airplane experienced fuel exhaustion, prompting the pilot to request landing clearance at a nearby airport. During the turn from base to final, the pilot was performing the normal and emergency checklists and the airplane overshot the runway. The pilot then tried to land on a residential street and the airplane struck a street light and a power pole with its left wing tip, and then impacted a set of high voltage power lines and a second power pole. The airplane came to rest in an inverted position suspended by the empennage from the power lines, with the nose of the airplane resting on the top of a parked car. The pilot and his two passengers egressed the airplane. During an examination of the engine, a new propeller was installed and the engine was started and it ran normally. The pilot reported no anomalies with the airplane or engine prior to or during the flight. According to the Federal Aviation Regulations, for VFR flight at night, the pilot was required to have a 45 minute reserve fuel supply available. ## Factual narrative On August 29, 2008, about 1856 Pacific daylight time, a Cessna 172N, N172ST, sustained substantial damage during a forced landing following a total loss of engine power near Burbank, California. The private pilot sustained serious injuries, and two passengers sustained minor injuries. The airplane was registered to Universal Aviators Academy of El Monte, California. Visual meteorological conditions prevailed for the personal cross-country flight, which was operated in accordance with 14 Code of Federal Regulations (CFR) Part 91, and a flight plan was not filed. The flight departed the Modesto City Airport, Harry Sham Field (MOD), about 1530. Its destination was reported to be Brackett Field (POC), La Verne, California. In a report submitted to the NTSB investigator-in-charge (IIC), the pilot, who had received his private pilot's license 3 days prior to the accident, stated that he planned the round-robin cross-country flight in order "to build hours." The pilot's route of flight was from the El Monte Airport (EMT), El Monte, California, to MOD, a distance of 286 nautical miles (nm) as indicated on the pilot's Flight Navigation Log. However, the pilot deviated from the planned route by first flying from EMT to POC to pick up a friend before departing for MOD; POC is 13 nm east of EMT. In a report submitted to the IIC by a Federal Aviation Administration (FAA) aviation safety inspector who conducted a post accident interview with the pilot, the inspector stated that prior to departing EMT the pilot had both fuel tanks filled, for a total of 43 gallons of fuel on board (40 gallons usable). The pilot reported that he was trained to use 8 to 10 gallons per hour as a cruise fuel burn for flight planning purposes. The pilot reported using an average ground speed of 98 knots, and recorded an en route time from EMT to MOD of 2.8 hours. The inspector reported that the flight departed EMT about 1200 and arrived at POC at 1220. It was estimated the flight departed POC for MOD at 1230, arriving MOD about 1315, for a flight time of 2.8 hours. The inspector calculated a total fuel burn between EMT and MOD to be 24.7 gallons, which equates to a fuel burn of 8.8 gallons per hour (gph). The inspector reported the airplane would have arrived at MOD with 15.3 gallons of fuel remaining. After landing at MOD the pilot filled both the left and right fuel tanks with 5 gallons of fuel each. This brought the total fuel load for the return flight to EMT up to 25.3 gallons, which equates to 2.8 hours of flight time at an average fuel burn of 9 gph. The pilot did not plan for the required 45 minute fuel reserve, or about 7 gallons, which would equate to a minimum fuel load from MOD to EMT of 32 gallons. The pilot reported that on the return flight to POC he was at 9,500 feet msl over the Van Nuys Airport (VNY), Van Nuys, California, which is about 35 nm west of POC, when the engine started to lose power. The pilot stated that he contacted air traffic control, informed thecontroller that he had a fuel problem, and requested landing clearance at the Bob Hope Airport (BUR), Burbank, California; BUR is located about 7 nm east of VNY. The pilot reported that at this point the engine was "producing zero thrust and the propeller was windmilling." He contacted the BUR tower and was cleared to land on Runway 15. The pilot stated that while turning from base leg to final approach he was also performing the normal and emergency checklists, which resulted in the airplane overshooting the runway. The pilot reported that he attempted to land on a residential street when the left wing struck a street light and powerlines. The airplane subsequently came to rest in an inverted position, suspended above the street by a powerline wrapped around the airplane's empennage, its nose resting on the roof of a parked car, and its right wing tip resting on the street's pavement. The airplane's left wing was folded back and upward at about a 45-degree angle parallel to the longitudinal axis of the airplane; its leading edge sustained impact damage. About the top one-half of the airplane's rudder had been severed, as well as the top 6 inches of its vertical stabilizer. The airplane's left forward cabin door area had come to rest against a telephone pole. All three landing gear remained intact. There was no postcrash fire. The FAA inspector conducted a postaccident examination of the engine. During the examination a new propeller was installed on the airplane and the engine was started. The engine ran normally and produced power with the movement of the throttle. The mixture control worked normally during the engine shutdown. The pilot reported no anomalies with the airplane or engine that would have precluded normal operation. The FAA inspector reported that it is common knowledge within the general aviation industry that "…these airplanes consume more fuel at cruise than what the Pilot Operating Handbook (POH) indicates. The industry standard of 8 to 10 per hour of fuel burn is common." The inspector reported that the pilot's Flight Navigation Log to MOD indicated that he had calculated a fuel burn of 8 to 10 gallons per hour. According to Federal Aviation Regulation (FAR) 91.151, under Visual Flight Rules (VFR), "Fuel requirements for flight in VFR conditions", states in part, "No person may begin a flight in an airplane under VFR conditions unless there is enough fuel to fly to the first point of intended landing and, assuming normal cruising speed, at night, to fly after that for at least 45 minutes. ## Aircraft - Registration: [N172ST](https://openairdocs.org/deregistered/N172ST-2009-09-04), registration cancelled 2009-09-04, S/N 17271289, built 1978 (OpenAirDocs) - Reported make and model: CESSNA 172N - Registry model: [Cessna 172N](https://openairdocs.org/model/cessna-172n) (registry code 2072434) (OpenAirDocs) - Registry engine: [Lycoming 0-320 series](https://openairdocs.org/engine/lycoming-0-320-series) (registry code 41508, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 17271289 - Airframe hours: 12285.5 - Engines: LYCOMING O-320 180 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Universal Aviators Academy Inc - Registered owner: Universal Aviators Academy Inc - Airworthiness certificate: Standard, Normal - Last inspection: Annual, August 27, 2008, 8 hours before - Departed: MOD, Modesto, CA - Destination: POC, La Verne, CA - Flight plan: Unknown - Airport: BUR, Bob Hope Airport, runway 15, 6,886 × 150 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 26; injuries: serious; private; airplane ratings: single-engine land; medical: class 1, without waivers/limitations; last flight review August 26, 2008; seat: left; flight hours: 106 total, 106 in this make and model, 6 in the last 90 days, 25 in the last 30 days, 6 in the last 24 hours ## Weather - Conditions: Visual (VMC), Night - Wind: 160° at 4 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 84 °F, dew point 61 °F - Altimeter: 29.70 inHg - Observed at: BUR, 1 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 20080829845779A](https://openairdocs.org/incident/20080829845779A), Aug 29, 2008: Cessna 172N, No damage. (-23) On August 29, 2008, at approximately 1856 PDT, N172ST, a Cessna CE-172N crashed on clybourne ave, approximately one half mile west of runway 15… ## Other investigations on N172ST (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 LAX94LA334](https://openairdocs.org/ntsb/LAX94LA334), Aug 22, 1994: Cessna 172 (N172ST), Mesa, AZ, substantial damage. Probable cause: THE STUDENT PILOT'S FAILURE TO MAINTAIN DIRECTIONAL CONTROL BY HIS IMPROPER USE OF THE FLIGHT CONTROLS. FACTORS RELATED TO THIS ACCIDENT WERE THE PILOT'S LACK OF TOTAL EXPERIENCE AND THE CROSSWIND. 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.