# NTSB WPR10LA357: Beech A36, N9SH, Phoenix, AZ, July 18, 2010 - Type: NTSB accident investigation - Classification: Accident · Serious injuries · Limited investigation · Final report - Date: July 18, 2010, 14:02 local (21:02 UTC) - Place: Phoenix, AZ - Coordinates: 33.688056, -112.082496 (estimated) - Nearby events: https://openairdocs.org/map.md?lat=33.6881&lon=-112.0825&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute-descent: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341) - Highest injury: Serious injuries - Injuries: 1 serious - Status: Completed, report August 29, 2012 - Report: Approved by Office Director - NTSB office: Western Pacific Region - Parties: Federal Aviation Adminstration - NTSB case key (mKey): 76665 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR10LA357 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/76665/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=76665 - Page: https://openairdocs.org/ntsb/WPR10LA357 ## Probable cause A loss of engine power during descent due to fuel starvation that resulted from the pilot's mismanagement of the fuel system. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Fluids: fuel](https://openairdocs.org/ntsb-findings/01071010): Aircraft › Fluids/misc hardware · Fluid management (probable cause); cases with it: [Beech A36, 22 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md?model=1151604), [All aircraft, 1,695 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md) - [Planning/preparation: fuel planning](https://openairdocs.org/ntsb-findings/02061030): Personnel issues › Task performance · Pilot (probable cause); cases with it: [Beech A36, 9 cases](https://openairdocs.org/ntsb-findings/02061030/cases.md?model=1151604), [All aircraft, 719 cases](https://openairdocs.org/ntsb-findings/02061030/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Emergency descent: Fuel starvation](https://openairdocs.org/ntsb-events/191); cases with it: [Beech A36, 15 cases](https://openairdocs.org/ntsb-events/191/sequence.md?model=1151604), [All aircraft, 733 cases](https://openairdocs.org/ntsb-events/191/sequence.md) - [Enroute-descent: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341) (defining event); cases with it: [Beech A36, 56 cases](https://openairdocs.org/ntsb-events/341/sequence.md?model=1151604), [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: [Beech A36, 47 cases](https://openairdocs.org/ntsb-events/440/sequence.md?model=1151604), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) - [Landing-landing roll: Collision with terr/obj (non-CFIT) ](https://openairdocs.org/ntsb-events/470); cases with it: [Beech A36, 78 cases](https://openairdocs.org/ntsb-events/470/sequence.md?model=1151604), [All aircraft, 10,189 cases](https://openairdocs.org/ntsb-events/470/sequence.md) ## Analysis The pilot reported flying for about an hour at 10,000 feet during a maintenance test flight to break in newly installed cylinders. The pilot reduced altitude to continue operating for another hour. As he changed altitude, he switched fuel tanks. Shortly after switching tanks, the engine lost power. During the forced landing, the airplane hit an automobile. Following the accident, about 1.5 gallons of fuel were recovered from the right fuel tank, and the left fuel tank was found empty. The right fuel tank was cracked and had leaked some fuel; the left fuel tank was not damaged. During the postaccident engine examination, no mechanical failures or malfunctions were revealed that would have precluded normal operation. The loss of engine power was most likely due to the pilot’s mismanagement of the fuel, resulting in fuel starvation. ## Factual narrative On July 18, 2010, at 1402 mountain standard time, a Beech A36, N9SH, was substantially damaged when it hit a automobile during an emergency landing about 1 mile west of the runway at Deer Valley Airport (DVT), Phoenix, Arizona. The private pilot, the sole occupant, received serious injuries. The driver of the vehicle, the sole occupant, received minor injuries. The maintenance test flight was conducted under the provisions of 14 Code of Federal Regulations Part 91, without a flight plan. Visual meteorological conditions prevailed. The local flight originated about 1300. According to a Federal Aviation Administration (FAA) inspector who responded to the accident scene, the engine lost power. During the forced landing, the airplane hit an automobile. The right wing and wingtip fuel tank were substantially damaged. Both tip tanks were compromised. The inspector reported that 1.5 gallons of fuel was recovered from the right wing tank and that the left fuel tank was empty. The left wing fuel tank was not damaged; however, the right wing fuel tank was cracked and had leaked fuel. The pilot was interviewed by an FAA inspector. The pilot reported that he had just completed a 'top overhaul’ of the engine and was performing a maintenance flight to break in the new cylinders. The pilot reported flying for about an hour at 10,000 feet. He decided to descend to a lower altitude; 6,500 feet, and continue operating the engine for another hour. As he changed altitude, he switched the fuel tank; he thought that the airplane fuel gauge was sticking because he knew there was fuel in the tank, and the airplane was still flying. As he contemplated the fuel gauge, the engine stopped running. The pilot stated that he was just north of DVT and set up for a landing. As the airplane turned onto final; the pilot realized that the airplane did not have enough altitude to make it to the airport, so he decided to land on Deer Valley Road. The engine was examined under the supervision of an FAA inspector. The inspector reported that there were no anomalies with the engine; however, the magneto would not produce a spark. Further examination of the magneto revealed a cracked magneto cap consistent with impact damage. The cap was replaced and the magneto performed as designed. An examination of the remaining aircraft systems revealed no anomalies. The pilot did not submit the required Pilot/Operator aircraft accident/incident report form. ## Aircraft - Registration: [N9SH](https://openairdocs.org/deregistered/N9SH-2013-12-02), registration cancelled 2013-12-02, S/N E-981, built 1977 (OpenAirDocs) - Reported make and model: BEECH A36 - Registry model: [Beech A36](https://openairdocs.org/model/beech-a36) (registry code 1151604) (OpenAirDocs) - Registry engine: [Continental IO-520 series](https://openairdocs.org/engine/continental-io-520-series) (registry code 17032, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: E-981 - Airframe hours: 3322 - Engines: Lycoming Engines TIO-540-J2BD 350 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: Reed Hatkoff - Registered owner: Reed Hatkoff - Airworthiness certificate: Standard, Normal - Last inspection: Annual, April 7, 2010 - Departed: DVT, Phoenix, AZ - Destination: DVT, Phoenix, AZ - Airport: DVT, Phoenix Deer Valley Airport ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 60; injuries: none; private; airplane ratings: single-engine land; medical: class 2, with waivers/limitations; seat: left; flight hours: 950 total ## Weather - Conditions: Visual (VMC), Dawn - Wind: 220° at 17 knots, gusting 20 - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 106 °F, dew point 61 °F - Altimeter: 29.82 inHg - Observed at: DVT, 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 20100718042219A](https://openairdocs.org/incident/20100718042219A), Jul 18, 2010: Beech A36, Phoenix, AZ, Substantial damage. N9SH was in a reportable accident on 7/18/2010 @ 1342HRS AZ local time. During a maintenance check flight the pilot reported loss of power. The emergency… ## Docket (4 files) The files NTSB released with the investigation on July 5, 2012, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=76665. 2.8 MB in all. - Pilot Interview (item 1, .PDF, 676 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371444&FileExtension=.PDF&FileName=Pilot%20Interview-Redacted.PDF - Maintenance Records (item 2, .PDF, 821 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40370794&FileExtension=.PDF&FileName=Maintenance%20Records-Redacted.PDF - Report from Federal Aviation Administration (item 3, .PDF, 239 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40371993&FileExtension=.PDF&FileName=Report%20from%20Federal%20Aviation%20Administration-Redacted.PDF - Report from Phoenix Police Department (item 4, .PDF, 1.1 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40372814&FileExtension=.PDF&FileName=Report%20from%20Phoenix%20Police%20Department-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. --- 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.