# NTSB WPR09FA102: Siai-Marchetti SF-260C, N688C, Santa Monica, CA, January 29, 2009

- Type: NTSB accident investigation
- Classification: Accident · Fatal · Field investigation · Final report
- Date: January 28, 2009, 17:05 local (Jan 29, 2009, 01:05 UTC)
- Place: Santa Monica, CA
- Coordinates: 34.662223, -118.456108
- Nearby events: https://openairdocs.org/map.md?lat=34.6622&lon=-118.4561&mi=10
- Phase of flight: [Takeoff](https://openairdocs.org/ntsb-phases/300) (OpenAirDocs' grouping)
- Defining event: [Takeoff: Fuel starvation](https://openairdocs.org/ntsb-events/191)
- Highest injury: Fatal
- Injuries: 2 fatal
- Status: Completed, report May 11, 2010
- Report: Approved by Office Director
- NTSB office: Western Pacific Region
- Parties: Federal Aviation Administration, Lycoming
- NTSB case key (mKey): 73286
- NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR09FA102
- NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/73286/pdf
- NTSB docket: https://data.ntsb.gov/Docket?ProjectID=73286
- Page: https://openairdocs.org/ntsb/WPR09FA102

## Probable cause

The pilot’s failure to select the proper fuel tank for takeoff, which resulted in a loss of engine power. Contributing to the accident was the pilot's failure to maintain aircraft control while attempting a return to runway maneuver.

## Findings

NTSB's coded findings; those marked are part of the probable cause.

- [Fuel system: fuel selector/shutoff valve](https://openairdocs.org/ntsb-findings/01022823): Aircraft › Aircraft systems · Incorrect use/operation (probable cause); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-findings/01022823/cases.md?model=8121212), [All aircraft, 176 cases](https://openairdocs.org/ntsb-findings/01022823/cases.md)
- [Use of equip/info: aircraft control](https://openairdocs.org/ntsb-findings/02063040): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-findings/02063040/cases.md?model=8121212), [All aircraft, 9,295 cases](https://openairdocs.org/ntsb-findings/02063040/cases.md)
- [Action: forgotten action/omission](https://openairdocs.org/ntsb-findings/02041035): Personnel issues › Action/decision · Pilot; cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-findings/02041035/cases.md?model=8121212), [All aircraft, 440 cases](https://openairdocs.org/ntsb-findings/02041035/cases.md)
- [Fluids: fuel](https://openairdocs.org/ntsb-findings/01071010): Aircraft › Fluids/misc hardware · Fluid management (probable cause); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-findings/01071010/cases.md?model=8121212), [All aircraft, 1,695 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md)
- [Use of equip/info: use of equip/system](https://openairdocs.org/ntsb-findings/02063015): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-findings/02063015/cases.md?model=8121212), [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md)
- [Performance/control parameters](https://openairdocs.org/ntsb-findings/01062000): Aircraft › Aircraft oper/perf/capability · Not attained/maintained (probable cause); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-findings/01062000/cases.md?model=8121212), [All aircraft, 1,269 cases](https://openairdocs.org/ntsb-findings/01062000/cases.md)

## Sequence of events

The events NTSB coded, in order, by phase of flight. The defining event best describes what happened.

- [Prior to flight: Aircraft inspection event](https://openairdocs.org/ntsb-events/050); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-events/050/sequence.md?model=8121212), [All aircraft, 229 cases](https://openairdocs.org/ntsb-events/050/sequence.md)
- [Takeoff: Fuel starvation](https://openairdocs.org/ntsb-events/191) (defining event); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-events/191/sequence.md?model=8121212), [All aircraft, 733 cases](https://openairdocs.org/ntsb-events/191/sequence.md)
- [Takeoff: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-events/341/sequence.md?model=8121212), [All aircraft, 3,820 cases](https://openairdocs.org/ntsb-events/341/sequence.md)
- [Emergency descent: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-events/440/sequence.md?model=8121212), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md)
- [Emergency descent: Loss of control in flight](https://openairdocs.org/ntsb-events/240); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-events/240/sequence.md?model=8121212), [All aircraft, 5,002 cases](https://openairdocs.org/ntsb-events/240/sequence.md)
- [Uncontrolled descent: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Siai-Marchetti SF-260C, 1 case](https://openairdocs.org/ntsb-events/470/sequence.md?model=8121212), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md)

## Analysis

Witnesses observed the airplane climb normally after takeoff until reaching an altitude between 200 to 400 feet, then the engine sound stopped. The airplane appeared to slow down as it made a right turn followed by a descending spin until impacting the runway. The main wing tanks had been topped off about 1 week before the accident by another pilot. The pilot reported that he taxied the airplane to the hangar with the fuel selector valve in the right tip fuel tank position per standard operating procedures for the airplane. The pilot stated that a small amount of fuel was in the tip tank; however, the exact quantity was not able to be determined. Postaccident on-site examination of the wreckage revealed that the fuel tank selector valve handle appeared to be in the right tip fuel tank position. Based on detailed examination of the selector, and the nature of the cockpit structure deformation, it was later determined that the fuel tank selector valve was out of its detent and was actually between the Right Tip Tank and the Both Tip Tank selections. The fuel tank selector was probably moved out of the selector detent as a result of the crushing forces and structural deformation around the selector handle during the impact sequence. The fuel tank selector valve assembly was disassembled and found to be operational. The approved airplane flight manual for the airplane indicated that the selector valve should be positioned on the left wing tank for starting. Both the manual and the placards on the instrument panel stated that the use of “Tip Tank” and “both Tips” is limited to level flight only. The airframe and engine were examined with no mechanical anomalies identified.

## Factual narrative

HISTORY OF FLIGHT On January 28, 2009, about 1705 Pacific standard time, an experimental Siai-Marchetti SF-260C, N688C, crashed during takeoff following a loss of engine power at Santa Monica Municipal Airport (SMO), Santa Monica, California. The pilot was operating the borrowed airplane under the provisions of 14 Code of Federal Regulations (CFR) Part 91. The certificated private pilot and passenger were killed; the airplane was substantially damaged by impact forces and the post crash fire. The local personal flight was departing SMO at the time of the accident. Visual meteorological conditions prevailed, and no flight plan was filed. During takeoff witnesses observed the airplane climb normally until reaching an altitude between 200 to 400 feet, then the engine sound suddenly stopped. The airplane appeared to slow down as it made a right turn followed by a descending spin until impacting the ground between Runway 21-3 and taxiway A. PERSONNEL INFORMATION A review of Federal Aviation Administration (FAA) airman records revealed that the 45-year-old pilot held a private pilot certificate with ratings for airplane single-engine land and helicopter. The pilot held a third-class medical certificate issued on March 2, 2007. It had no limitations or waivers. No personal flight records were located for the pilot. The aeronautical experience listed in this report was obtained from FAA airmen medical records on file in the Airman and Medical Records Center. The pilot reported on his most recent medical application that he had a total time of 1,400 flight hours. In May 2008, the insurance company for the accident airplane added the pilot to the approved pilot list for the airplane. At that time the pilot reported 1,600 hours total flight time, with 5 hours in make and model. The owner of the airplane estimated that the accident pilot had accumulated about 20 hours of flight time in the make and model airplane involved in the accident. AIRCRAFT INFORMATION The airplane was a Siai-Marchetti, SF-260C, serial number 466 (37-004). A review of the airplane’s logbooks revealed that the airplane had a total airframe time of 3,654.6 hours at the last condition inspection, which was completed on July 1, 2008. The airplane was powered by a Textron Lycoming IO-540-D4A5, serial number L-19695-40, rated at 260 horsepower. Total time recorded on the engine at the last 100-hour inspection was 2,845.2 hours; time since major overhaul was 1,512.9 hours. Fueling records at SMO established that the airplane was last fueled on January 20, 2009, with the addition of 11.7 gallons of 100LL-octane aviation fuel, topping off the main wing tanks. The pilot who refueled the airplane stated that after refueling he taxied the airplane back to the hangar with the right tip fuel tank selected, which he reported was standard operating procedure in this airplane. He also stated that the tip tanks had a very small amount of fuel; the exact quantity was undetermined. Examination of themaintenance records revealed no unresolved maintenance discrepancies against the airplane and or engine prior to departure. COMMUNICATIONS The airplane was cleared for departure by Santa Monica tower Air Traffic Controllers. No distress transmissions were recorded from the pilot prior to the accident. AIRPORT INFORMATION The Airport Facility Directory, Southwest U. S., indicated that SMO runway 21 was 4,973 feet long and 150 feet wide. The runway surface was asphalt. WRECKAGE AND IMPACT INFORMATION Investigators examined the wreckage at the accident site. The accident site was located on the northwest side of runway 21/3 on turnoff A-1 between taxiway A and runway 21/3. The first identified point of contact (FIPC) was a ground scar, which was an impression of the right wing with scrape marks and paint transfer oriented towards the main wreckage. The debris field was contained within a 50-foot radius of the main wreckage. The fuselage was orientated on a 300-degree heading. Extensive thermal and impact related damage was noted to both wings and fuselage. The tail section sustained thermal and impact damage, but to a lesser degree than the wings and fuselage. During documentation of the accident site investigators observed the fuel tank selector valve handle appeared to be selected to the right tip fuel tank. The valve and handle assembly was examined on site and it was determined that the assembly was physically frozen in place due to the aircraft structure crushing around the selector assembly. The extensive impact damage and crushing forces upon the airplane structure around the fuel tank selector assembly made it difficult to positively identify the actual position of the fuel valve selector prior to the examination. The fuel tank selector valve assembly was cut from the main wreckage and secured for further examination. MEDICAL AND PATHOLOGICAL INFORMATION The Los Angeles County Coroner completed an autopsy on the pilot on January 31, 2009. The cause of death was listed as the result of multiple traumatic injuries. The FAA Civil Aerospace Medical Institute (CAMI), Oklahoma City, Oklahoma, performed toxicological testing of specimens of the pilot. Analysis of the specimens contained no findings for carbon monoxide, cyanide, volatiles, and tested drugs. TESTS AND RESEARCH Investigators examined the wreckage at Aircraft Recovery Service, Littlerock, California, on March 10, 2009. The airframe and engine were examined with no mechanical anomalies identified. Investigators examined the fuel valve selector assembly at Stealth Aviation, Santa Monica, California, on April 14, 2009. The investigators determined that the fuel tank selector valve, which was originally believed to be positioned to the right tip tank position, was actually positioned out of its detent and was between the Right Tip Tank and the Both Tip Tank selection, as a result of the impact forces displacing the selector valve. The fuel tank selector valve assembly was disassembled andfound to be operational and undamaged. The fuel tank selector valve has five selection positions; Left Tip Tank, Left Main Tank, Right Main Tank, Right Tip Tank, and Both Tip Tanks. ADDITIONAL INFORMATION A review of the approved airplane flight manual for the Siai-Marchetti F260 revealed that the use of “Tip Tank” and “both Tips” is limited to level flight only. The Normal Operating Procedures sections indicated that before starting the engine, the fuel selector valve should be positioned on the left wing tank. Investigators noted during the post accident examination that there was a placard on the instrument panel which stated “USE WING TIP TANKS IN LEVEL FLIGHT ONLY.”

## Aircraft

- Registration: [N688C](https://openairdocs.org/deregistered/N688C-2017-02-16), registration cancelled 2017-02-16, S/N 466 (37-004) (OpenAirDocs)
- Reported make and model: SIAI-MARCHETTI SF-260C
- Registry model: [Siai-Marchetti SF-260C](https://openairdocs.org/model/siai-marchetti-sf-260c) (registry code 8121212) (OpenAirDocs)
- Registry engine: [Lycoming IO-540 series](https://openairdocs.org/engine/lycoming-io-540-series) (registry code 41530, reciprocating) (OpenAirDocs)
- Category: Airplane
- Serial number: 466 (37-004)
- Airframe hours: 3655
- Engines: LYCOMING AEIO-540-D4A5 260 horsepower reciprocating
- Damage: Substantial damage
- Fire: On-Ground
- Flight: Personal, Part 91
- Airworthiness certificate: Special, Experimental (Special)
- Last inspection: 100 hour, July 1, 2008, 90 hours before
- Departed: SMO, Santa Monica, CA
- Destination: SMO, Santa Monica, CA
- Flight plan: Unknown
- Airport: SMO, Santa Monica Municipal Airport, runway 21, 4,973 × 150 ft, asphalt

## Flight crew

As NTSB recorded them. NTSB leaves out names.

- Pilot; age 46; injuries: fatal; private; airplane ratings: single-engine land; medical: class 3, without waivers/limitations; seat: right; flight hours: 1,600 total, 5 in this make and model

## Weather

- Conditions: Visual (VMC), Day
- Wind: calm
- Visibility: 10 statute miles
- Lowest ceiling: none
- Temperature: 64 °F, dew point 19 °F
- Altimeter: 30.13 inHg
- Observed at: SMO, 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 20090128001369A](https://openairdocs.org/incident/20090128001369A), Jan 28, 2009: Mrchti SF260C, Santa Monica, CA, Destroyed, 2 fatal. N688C, a sai marchetti 260-C certificated as an experimental exhibition aircraft operating under FAR part 91, crashed on departure from runway 21 at the Santa…

## Docket (21 files)

The files NTSB released with the investigation on March 12, 2010, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=73286. 5.8 MB in all.

- Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 700 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40307844&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF
- Witness Statement- Malachowski (item 2, .PDF, 15 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325354&FileExtension=.PDF&FileName=Witness%20Statement-%20Malachowski-Redacted.PDF
- Witness Statement - McCaughley (item 3, .PDF, 104 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40327050&FileExtension=.PDF&FileName=Witness%20Statement%20-%20McCaughley-Redacted.PDF
- Witness Statement- Mundt (item 4, .PDF, 16 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325356&FileExtension=.PDF&FileName=Witness%20Statement-%20Mundt-Redacted.PDF
- Wreckage Site Diagram & Measurements (item 5, .PDF, 316 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325371&FileExtension=.PDF&FileName=Wreckage%20Site%20Diagram%20%26%20Measurements-Master.PDF
- PHOTO 1- Fuel Valve Position at Accident Site (item 6, .PDF, 80 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325372&FileExtension=.PDF&FileName=PHOTO%201-%20Fuel%20Valve%20Position%20at%20Accident%20Site-Master.PDF
- PHOTO 2- Fuel Valve as Removed (item 7, .PDF, 78 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325373&FileExtension=.PDF&FileName=PHOTO%202-%20Fuel%20Valve%20as%20Removed-Master.PDF
- PHOTO 3- Fuel Valve Port Layout (item 8, .PDF, 54 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325374&FileExtension=.PDF&FileName=PHOTO%203-%20Fuel%20Valve%20Port%20Layout-Master.PDF
- PHOTO 4- Fuel Valve Port Layout 2 (item 9, .PDF, 55 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325375&FileExtension=.PDF&FileName=PHOTO%204-%20Fuel%20Valve%20Port%20Layout%202-Master.PDF
- PHOTO 5- Fuel Valve Close-Up (item 10, .PDF, 75 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325376&FileExtension=.PDF&FileName=PHOTO%205-%20Fuel%20Valve%20Close-Up-Master.PDF
- PHOTO 6- Fuel Valve Disassembly (item 11, .PDF, 61 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325377&FileExtension=.PDF&FileName=PHOTO%206-%20Fuel%20Valve%20Disassembly-Master.PDF
- PHOTO 7- Accident Site (item 12, .PDF, 833 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325378&FileExtension=.PDF&FileName=PHOTO%207-%20Accident%20Site-Master.PDF
- Field Notes- Lycoming (item 13, .PDF, 47 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325380&FileExtension=.PDF&FileName=Field%20Notes-%20Lycoming-Master.PDF
- Toxicological Report- Emanuele (item 14, .PDF, 106 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325381&FileExtension=.PDF&FileName=Toxicological%20Report-%20Emanuele-Master.PDF
- Toxicological Report- Schaedel (item 15, .PDF, 106 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325382&FileExtension=.PDF&FileName=Toxicological%20Report-%20Schaedel-Master.PDF
- N688C Aircraft Logbook Entries (item 16, .PDF, 1.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325384&FileExtension=.PDF&FileName=N688C%20Aircraft%20Logbook%20Entries-Redacted.PDF
- N688C Engine Logbook Entries (item 17, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325612&FileExtension=.PDF&FileName=N688C%20Engine%20Logbook%20Entries-Redacted.PDF
- Diagram of Fuel Selector Valve (item 18, .PDF, 132 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325620&FileExtension=.PDF&FileName=Diagram%20of%20Fuel%20Selector%20Valve-Master.PDF
- Reported Pilot Times as of May 2008 (item 19, .PDF, 13 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325622&FileExtension=.PDF&FileName=Reported%20Pilot%20Times%20as%20of%20May%202008-Redacted.PDF
- Statement of Party Representatives to NTSB Investigation (item 20, .PDF, 58 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325623&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF
- Release of Aircraft Wreckage, NTSB Form 6120.15 (item 21, .PDF, 537 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40325625&FileExtension=.PDF&FileName=Release%20of%20Aircraft%20Wreckage,%20NTSB%20Form%206120.15-Redacted.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.

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