# NTSB SEA91LA169: Beech B19, N24576, Bend, OR, July 14, 1991

- Type: NTSB accident investigation
- Classification: Accident · Minor injuries · Limited investigation · Final report
- Date: July 14, 1991, 13:00 local (20:00 UTC)
- Place: Bend, OR
- Coordinates: 44.069194, -121.249778 (estimated)
- Nearby events: https://openairdocs.org/map.md?lat=44.0692&lon=-121.2498&mi=10
- Phase of flight: [Initial climb](https://openairdocs.org/ntsb-phases/350) (OpenAirDocs' grouping)
- Highest injury: Minor injuries
- Injuries: 2 minor
- Status: Completed, report May 27, 1993
- Report: Approved by Office Director
- NTSB case key (mKey): 41481
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=SEA91LA169
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/41481/pdf
- Page: https://openairdocs.org/ntsb/SEA91LA169

## Probable cause

POOR PREFLIGHT PLANNING/PREPARATION BY THE PILOT IN COMMAND. FACTORS TO THE ACCIDENT WERE: HIGH DENSITY ALTITUDE, EXCESSIVE CLIMB RATE, INADEQUATE REMEDIAL ACTION, AND LACK OF TOTAL FLIGHT EXPEREINCE.

## Sequence of events

In NTSB's coding before 2008 (https://www.ntsb.gov/GILS/Documents/codman.pdf).

- Loss of control - in flight, takeoff - initial climb
  - weather condition - high density altitude (contributing factor)
  - lack of total experience, pilot in command (contributing factor)
  - proper climb rate - excessive, pilot in command (contributing factor)
  - remedial action - inadequate, pilot in command (contributing factor)
  - preflight planning/preparation - poor, pilot in command (cause)
- In flight collision with terrain/water, takeoff - initial climb

## Analysis

AT THE BEGINNING OF A FLIGHT, THE AIRPLANE ROTATED NORMALLY AND ATTAINED AN ALTITUDE OF 30 TO 40 FEET WHEN THE AIRSPEED DROPPED AND THE AIRPLANE SETTLED TO THE RUNWAY.  WITNESSES REPORTED THAT THE ANGLE OF ATTACK INCREASED TO 25 DEGREES WHEN THE AIRPLANE LIFTED OFF.  BEFORE THE AIRPLANE REACHED THE END OF THE RUNWAY, THE NOSE DROPPED AS DID THE RIGHT WING AND THE AIRPLANE SETTLED TO THE RUNWAY.

## Aircraft

- Registration: [N24576](https://openairdocs.org/deregistered/N24576-1994-03-31), registration cancelled 1994-03-31, S/N MB545 (OpenAirDocs)
- Reported make and model: BEECH B19
- Registry model: [Beech B19](https://openairdocs.org/model/beech-b19) (registry code 1151215) (OpenAirDocs)
- Category: Airplane
- Serial number: MB-545
- Engines: LYCOMING O-320-E2O 150 horsepower reciprocating
- Damage: Substantial damage
- Flight: Personal, Part 91
- Operator: Wayne O. & Lois M. Bozarth
- Registered owner: Wayne O. & Lois M. Bozarth
- Destination: EKA, EUREKA, CA
- Airport: S21, Sunriver, runway 18, 5,500 × 65 ft, asphalt

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 44; private; airplane ratings: single-engine land; medical: class 3, valid medical--no waivers/lim.; flight hours: 161 total, 63 in this make and model, 111 as pilot in command, 11 in the last 90 days, 5 in the last 30 days, 3 in the last 24 hours

## Weather

- Conditions: Visual (VMC), Day
- Wind: 290° at 7 knots
- Visibility: 10 statute miles
- Lowest ceiling: none
- Temperature: 73 °F, dew point 41 °F
- Altimeter: 29.00 inHg
- Observed at: RDM, 26 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 19910714027189A](https://openairdocs.org/incident/19910714027189A), Jul 14, 1991: Beech B19, Bend, OR, Substantial damage. Rotated to a high pitch angle on takeoff. Aircraft stalled and collided with the runway. Density altitude 6000 feet

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.

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