# NTSB WPR12LA188: Hawker Beech V35B, N2841W, Coalinga, CA, April 28, 2012 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: April 28, 2012, 09:58 local (16:58 UTC) - Place: Coalinga, CA - Coordinates: 36.347499, -120.310279 - Nearby events: https://openairdocs.org/map.md?lat=36.3475&lon=-120.3103&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute-cruise: Fuel starvation](https://openairdocs.org/ntsb-events/191) - Highest injury: No injuries - Injuries: 4 uninjured - Status: Completed, report February 14, 2013 - Report: Approved by Office Director - NTSB office: Western Pacific Region - Parties: Federal Aviation Administration - NTSB case key (mKey): 83500 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=WPR12LA188 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/83500/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=83500 - Page: https://openairdocs.org/ntsb/WPR12LA188 ## Probable cause The pilot's improper fuel management, which resulted in a loss of engine power due to fuel starvation. ## 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 V35B, 3 cases](https://openairdocs.org/ntsb-findings/01071010/cases.md?model=1151548), [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: [Beech V35B, 7 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md?model=1151548), [All aircraft, 1,391 cases](https://openairdocs.org/ntsb-findings/02063015/cases.md) - [Action: delayed action](https://openairdocs.org/ntsb-findings/02041025): Personnel issues › Action/decision · Pilot; cases with it: [Beech V35B, 3 cases](https://openairdocs.org/ntsb-findings/02041025/cases.md?model=1151548), [All aircraft, 894 cases](https://openairdocs.org/ntsb-findings/02041025/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute-cruise: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341); cases with it: [Beech V35B, 10 cases](https://openairdocs.org/ntsb-events/341/sequence.md?model=1151548), [All aircraft, 3,820 cases](https://openairdocs.org/ntsb-events/341/sequence.md) - [Enroute-cruise: Fuel starvation](https://openairdocs.org/ntsb-events/191) (defining event); cases with it: [Beech V35B, 3 cases](https://openairdocs.org/ntsb-events/191/sequence.md?model=1151548), [All aircraft, 733 cases](https://openairdocs.org/ntsb-events/191/sequence.md) - [Landing: Landing gear not configured](https://openairdocs.org/ntsb-events/095); cases with it: [Beech V35B, 3 cases](https://openairdocs.org/ntsb-events/095/sequence.md?model=1151548), [All aircraft, 584 cases](https://openairdocs.org/ntsb-events/095/sequence.md) ## Analysis While in cruise flight, the engine lost power while the fuel selector was positioned on the left tank. The pilot positioned the fuel selector to the right tank and the engine momentarily regained power. However, the engine gradually lost power completely and did not regain power again, although the pilot switched back and forth between the right and left fuel tanks. The pilot conducted a forced landing on a road. The pilot inadvertently delayed extending the landing gear; as a result, the landing gear was only partially extended and subsequently collapsed when the airplane touched down on the paved road, resulting in substantial damage to the airplane. Postaccident examination revealed minimal fuel in the left tank and about 20 gallons in the right tank. The engine was subsequently run successfully, and no mechanical malfunctions or failures that would have precluded normal operation were observed. It is likely that the loss of engine power was due to fuel starvation. ## Factual narrative On April 28, 2012, at 0958 Pacific daylight time (PDT), a Hawker Beech V35B airplane, N2841W, lost engine power during flight and the pilot landed the airplane on a road near Coalinga, California. The private pilot was operating the airplane under the provisions of Title 14 Code of Federal Regulations Part 91. The airplane sustained substantial damage. The pilot and three passengers were not injured. Visual meteorological conditions prevailed and no flight plan was filed. The pilot departed from Sacramento Executive Airport, Sacramento, California, about 0905 PDT. According to the pilot, approximately 8 miles from his destination he heard a change in engine power. He switched from the left fuel tank to the right fuel tank and monitored the fuel flow. The engine momentarily regained power, but then the fuel flow continued to decrease until the engine lost power. Throughout the loss of power, the pilot continued to switch the fuel selector back and forth between the fuel tanks until the engine lost full power. The pilot then landed the airplane on a road. During the landing, extension of the landing gear was delayed and the right main landing gear and nose landing gear collapsed upon touchdown. The pilot indicated that the airplane was not at an altitude where a restart attempt could be conducted. Examination of the fuel of the accident site showed minimal fuel in the left tank and approximately 20 gallons in the right tank. An NTSB investigator examined the wreckage following the accident. The engine was test run using an external fuel source and no anomalies were identified. Examination of the fuel tank vents revealed that they were free of obstruction. There were no pre-impact anomalies identified that would have resulted in a loss of engine power. According to the pilot operating handbook (POH), when a rough running engine occurs, the pilot should perform the following: 1. Mixture- full rich, then lean as required 2. Magneto/Start Switch- Check left and right, then both 3. Alternate Air T-Handle- Pull and Release For a loss of engine power, it reports the following: 1. Fuel Flow Gage- Check If fuel flow is abnormally low: a. Mixture- full rich b. Auxiliary Fuel Pump- On (lean as required) c. Auxiliary Fuel Pump - Off if performance does not improve in a few moments 2. Fuel Quantity Indicator- Check for fuel supply in tank being used 3. Alternate Air T-Handle- Pull and Release If tank being used is empty: Fuel Tank Selector Valve- Select other fuel tank (feel for detent and check visually) ## Aircraft - Registration: [N2841W](https://openairdocs.org/deregistered/N2841W-2017-10-26), registration cancelled 2017-10-26, S/N D-9493, built 1973 (OpenAirDocs) - Reported make and model: Hawker Beech V35B - Registry model: [Beech V35B](https://openairdocs.org/model/beech-v35b) (registry code 1151548) (OpenAirDocs) - Registry engine: [Continental IO-520 series](https://openairdocs.org/engine/continental-io-520-series) (registry code 17032, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: D-9493 - Airframe hours: 4178 - Engines: Continental Motors IO-550-B4F 300 horsepower reciprocating - Damage: Substantial damage - Flight: Personal, Part 91 - Operator: David Chelini - Registered owner: David Chelini - Airworthiness certificate: Standard, Utility; Standard, Normal - Last inspection: Annual, April 4, 2012, 2 hours before - Departed: SAC, Sacramento, CA - Destination: 308, Coalinga, CA - Airport: 308, Harris Ranch Airport ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 69; injuries: none; private; airplane ratings: single-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; last flight review November 27, 2011; seat: left; flight hours: 1,847 total, 581 in this make and model, 1,726 as pilot in command, 4 in the last 90 days, 2 in the last 30 days, 1 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 330° at 14 knots, gusting 19 - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 66 °F, dew point 41 °F - Altimeter: 30.04 inHg - Observed at: NLC, 15 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 20120428009879A](https://openairdocs.org/incident/20120428009879A), Apr 28, 2012: Beech V35B, Coalinga, CA, Substantial damage. The aircraft engine lost power and the pilot made an emergency landing on a highway. The right MLG folded and the nose gear broke completly off. There were no… ## Docket (7 files) The files NTSB released with the investigation on December 27, 2012, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=83500. 5.8 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 384 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40380146&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Pilot Record of Conversation (item 2, .PDF, 63 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40381984&FileExtension=.PDF&FileName=Pilot%20Record%20of%20Conversation-Master.PDF - Engine Examination Summary (item 3, .PDF, 53 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40380145&FileExtension=.PDF&FileName=Engine%20Examination%20Summary-Master.PDF - FAA Record of Conversation (item 4, .PDF, 24 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40380287&FileExtension=.PDF&FileName=FAA%20Record%20of%20Conversation-Master.PDF - Airplane POH Excerpts (item 5, .PDF, 2.4 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40382958&FileExtension=.PDF&FileName=Airplane%20POH%20Excerpts-Master.PDF - Photo 1. Airplane (item 6, .PDF, 2.8 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40381962&FileExtension=.PDF&FileName=Photo%201.%20Airplane-Master.PDF - Photo 2. Airplane at Accident Site (Provided by Police) (item 7, .PDF, 41 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40381966&FileExtension=.PDF&FileName=Photo%202.%20Airplane%20at%20Accident%20Site%20(Provided%20by%20Police)-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.