# NTSB WPR09CA467: Beech 35-C33, N90LP, Tillamook, OR, September 27, 2009 - Type: NTSB accident investigation - Classification: Accident · No injuries · Data collection · Final report - Date: September 27, 2009, 11:15 local (18:15 UTC) - Place: Tillamook, OR - Coordinates: 45.420276, -123.814163 - Nearby events: https://openairdocs.org/map.md?lat=45.4203&lon=-123.8142&mi=10 - Phase of flight: [Emergency descent](https://openairdocs.org/ntsb-phases/600) (OpenAirDocs' grouping) - Defining event: [Emergency descent: Fuel exhaustion](https://openairdocs.org/ntsb-events/192) - Highest injury: No injuries - Injuries: 4 uninjured - Status: Completed, report December 29, 2009 - Report: Approved by Office Director - NTSB office: Western Pacific Region - Parties: Federal Aviation Administration - NTSB case key (mKey): 74810 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR09CA467 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/74810/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=74810 - Page: https://openairdocs.org/ntsb/WPR09CA467 ## Probable cause A loss of engine power due to fuel exhaustion as a result of the pilot's failure to visually verify that sufficient fuel was on board prior to flight. Contributing to the accident was a malfunctioning fuel gage. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Fuel system: fuel quantity indicator](https://openairdocs.org/ntsb-findings/01022841): Aircraft › Aircraft systems · Malfunction (probable cause); cases with it: [Beech 35-C33, 1 case](https://openairdocs.org/ntsb-findings/01022841/cases.md?model=1151408), [All aircraft, 35 cases](https://openairdocs.org/ntsb-findings/01022841/cases.md) - [Fluids: fuel](https://openairdocs.org/ntsb-findings/01071010): Aircraft › Fluids/misc hardware · Fluid level (probable cause); cases with it: [Beech 35-C33, 3 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md?model=1151408), [All aircraft, 1,695 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md) - [Action: incomplete action](https://openairdocs.org/ntsb-findings/02041040): Personnel issues › Action/decision · Pilot (probable cause); cases with it: [Beech 35-C33, 1 case](https://openairdocs.org/ntsb-findings/02041040/cases.md?model=1151408), [All aircraft, 105 cases](https://openairdocs.org/ntsb-findings/02041040/cases.md) - [Inspection: preflight inspection](https://openairdocs.org/ntsb-findings/02061510): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Beech 35-C33, 1 case](https://openairdocs.org/ntsb-findings/02061510/cases.md?model=1151408), [All aircraft, 551 cases](https://openairdocs.org/ntsb-findings/02061510/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Landing: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Beech 35-C33, 2 cases](https://openairdocs.org/ntsb-events/440/sequence.md?model=1151408), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) - [Emergency descent: Fuel exhaustion](https://openairdocs.org/ntsb-events/192) (defining event); cases with it: [Beech 35-C33, 2 cases](https://openairdocs.org/ntsb-events/192/sequence.md?model=1151408), [All aircraft, 804 cases](https://openairdocs.org/ntsb-events/192/sequence.md) ## Analysis The pilot stated during the preflight, he checked the fuel gages which indicated 12 gallons in the left wing and 18 gallons in the right wing. The right wing tank indicated just below half a tank. The pilot stated that "it is not possible to visually gauge the fuel quantity once the amount is below 30 gallons per tank," and that it is difficult to know exactly how much fuel is in the airplane. About 24 minutes after takeoff the pilot reported that the engine experienced initial indications of low fuel while operating from the left fuel tank. The pilot then switched to the right fuel tank. Instead of proceeding to his destination, 35 miles away, the pilot diverted to a closer airport, 15 miles away. After 5 minutes, the engine again demonstrated conditions consistent with low fuel. Not believing that he could make the runway, the pilot decided to make a precautionary landing in a cattle pasture about 1 mile from the airport. During the landing, the right main landing gear collapsed and the right wing was structurally damaged. Post-accident inspection of the fuel system found that both fuel tanks were nearly empty of fuel. Inspection of the right fuel gage indicated about 1/3, when in fact the fuel tank was empty. ## Factual narrative The pilot stated during the preflight, he checked the fuel gages which indicated 12 gallons in the left wing and 18 gallons in the right wing. The right wing tank indicated just below half a tank. The pilot stated that "it is not possible to visually gauge the fuel quantity once the amount is below 30 gallons per tank," and that it is difficult to know exactly how much fuel is in the airplane. About 24 minutes after takeoff the pilot reported that the engine experienced initial indications of low fuel while operating from the left fuel tank. The pilot then switched to the right fuel tank. Instead of proceeding to his destination, 35 miles away, the pilot diverted to a closer airport, 15 miles away. After 5 minutes, the engine again demonstrated conditions consistent with low fuel. Not believing that he could make the runway, the pilot decided to make a precautionary landing in a cattle pasture about 1 mile from the airport. During the landing, the right main landing gear collapsed and the right wing was structurally damaged. Post-accident inspection of the fuel system found that both fuel tanks were nearly empty of fuel. Inspection of the right fuel gage indicated about 1/3, when in fact the fuel tank was empty. ## Aircraft - Registration: [N90LP](https://openairdocs.org/deregistered/N90LP-2015-05-11), registration cancelled 2015-05-11, S/N CD-1047, built 1966 (OpenAirDocs) - Reported make and model: BEECH 35-C33 - Registry model: [Beech 35-C33](https://openairdocs.org/model/beech-35-c33) (registry code 1151408) (OpenAirDocs) - Registry engine: [Continental I0-470 series](https://openairdocs.org/engine/continental-i0-470-series) (registry code 17027, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: CD-1047 - Airframe hours: 3108 - Engines: CONT MOTOR IO-470 SERIES 260 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Erman David G - Registered owner: Erman David G - Airworthiness certificate: Standard, Normal - Last inspection: Annual, August 25, 2009 - Departed: KS45, Gleneden Beach, OR - Destination: KAST, Astoria, OR - Airport: KTMK, Tillamook Airport ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 50; injuries: none; flight instructor, airline transport; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 1, without waivers/limitations; last flight review July 19, 2009; seat: left; flight hours: 18,000 total, 250 in this make and model, 11,000 as pilot in command, 260 in the last 90 days, 80 in the last 30 days ## Weather - Conditions: Visual (VMC), Day - Wind: calm - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 63 °F, dew point 46 °F - Altimeter: 30.06 inHg - Observed at: KHIO, 37 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 20090927018139A](https://openairdocs.org/incident/20090927018139A), Sep 27, 2009: Beech 35C33, Tillamook, OR, Substantial damage. Aircraft departed KS45 (siletz bay) for kast (astoria), a flight 42 minutes. Pilot calculated 10 gallons of fuel required for trip. Preflight of fuel quantity… ## Docket (4 files) The files NTSB released with the investigation on October 16, 2009, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=74810. 1.4 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 165 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320052&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Pilot Record of Conversation (item 2, .PDF, 13 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40319945&FileExtension=.PDF&FileName=Pilot%20Record%20of%20Conversation-Redacted.PDF - FAA Inspector's Statement (item 3, .PDF, 11 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320021&FileExtension=.PDF&FileName=FAA%20Inspector%27s%20Statement-Redacted.PDF - Photo 1 - On scene (item 4, .PDF, 1.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40319946&FileExtension=.PDF&FileName=Photo%201%20-%20On%20scene-Master.PDF 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.