Aviation Accident Summaries

Aviation Accident Summary CHI06FA090

Holland, MI, USA

Aircraft #1

N8271D

Beech J35

Analysis

The airplane impacted an embankment following a reported loss of engine power while on approach. Night visual meteorological conditions prevailed. A witness stated, "The pilot of N8271D announced that he was 10 miles or so south of the airport and was inbound for runway 26. ... He replied that he would join 8 for a right downwind and would follow us in. ... The pilot of 71D continued to make radio calls announcing his progress in the traffic pattern. We were waiting at the end of the taxiway for 71D to land. We saw the landing lights as 71D turned to final. As we watched 7ID's progress on final, suddenly the lights simply disappeared. ... It did appear to me that 71D was at an unusually steep descent angle." The witness stated that the pilot said over the headset that the airplane lost engine power. She stated that the airplane was in a turn while on approach during the reported engine power loss. An on scene investigation revealed that the left and right auxiliary fuel tanks contained a fluid that exhibited a smell consistent with aviation gasoline (avgas). The left and right main fuel tanks did not contain any fluids. Flight control continuity and engine control continuity was established. The fuel tank selector was found in the detent selecting the left main tank. Air pressure was applied to the fuel supply line and air was heard escaping in the left main fuel tank. An inspection of the left main fuel tank revealed no anomalies. Battery power was applied to the electric fuel pump with the fuel selector selecting the left main tank and no fluids were observed exiting the fuel supply line to the engine driven fuel pump. The fuel selector was rotated to the detent for the auxiliary tank, battery power was applied to the electric fuel pump, and a fluid consistent with avgas exited from the same supply line. The engine's crankshaft propeller flange had separated from the crankshaft and remained attached to the propeller. A propeller flange was welded to the engine's crankshaft and the engine was test run with no anomalies detected.

Factual Information

HISTORY OF FLIGHT On March 6, 2006, about 2045 eastern standard time, a Beech J35, N8271D, piloted by a private pilot, sustained substantial damage on impact with a roadway embankment following a reported loss of engine power while on approach to runway 8 at the Tulip City Airport, near Holland, Michigan. The personal flight was operating under 14 CFR Part 91. Night visual meteorological conditions prevailed at the time of the accident. An instrument flight plan was on file, was activated, and was closed. The passenger in the rear seat sustained minor injuries. The pilot and pilot-rated passenger in the front seat sustained serious injuries, were airlifted to a hospital, and died of their injuries. The flight originated from the Anderson Regional Airport (AND), near Anderson, South Carolina, about 1645. A witness, who was a flight instructor, stated: On Monday, March 6, 2006, a flight student and I were practicing night takeoffs and landings at Tulip City Airport (BIV). The time was between 8:30 - 9:00 p.m. It was a clear night with calm winds. We had just departed runway 8 and had announced that we would be remaining in the pattern. The pilot of N8271D announced that he was 10 miles or so south of the airport and was inbound for runway 26. We told 71D that we had just departed runway 8 and were remaining in the pattern. He replied that he would join 8 for a right downwind and would follow us in. We landed, exited the runway and taxied back to the approach end of runway 8 for another takeoff and landing. The pilot of 71D continued to make radio calls announcing his progress in the traffic pattern. We were waiting at the end of the taxiway for 71D to land. We saw the landing lights as 71D turned to final. As we watched 7ID's progress on final, suddenly the lights simply disappeared. I made a radio call to 71D but received no reply. It did appear to me that 71D was at an unusually steep descent angle. The pilot of 71D never indicated that he was having a problem. The passenger seated in the right rear seat stated that the pilot said over the headset that the airplane lost engine power. She stated that the airplane was in a turn while on approach during the reported engine power loss. PERSONNEL INFORMATION The pilot held a private pilot certificate with airplane single-engine land and instrument airplane ratings. The most recent medical certificate issued to the pilot was a third-class medical certificate issued on January 12, 2006, with no restrictions. According to Federal Aviation Administration (FAA) records, his total reported aeronautical experience was 1,400 flight hours at the time of the application for that medical certificate. The pilot rated passenger held a private pilot certificate, with ratings for airplane single engine land, and instrument airplane. The most recent medical certificate issued to the pilot rated passenger was a third-class medical certificate issued on August 17, 2005, with restrictions to wear corrective lenses. The pilot rated passenger had reported accumulating 1,000 hours of total flight experience at the time of the application for that medical certificate. AIRCRAFT INFORMATION N8271D, a 1958-model Beech J35, Bonanza, was a low wing, all-metal, single-engine, V-tailed, four-place monoplane, which had retractable tricycle landing gear. The airplane was equipped with a fuel-injected, air-cooled, six-cylinder, horizontally-opposed, Continental IO-520-BA engine, serial number 200932-72BA, which was rated at 285 horsepower, and a Hartzell 3-bladed, all-metal, constant-speed propeller. According to the aircraft's maintenance records, the last recorded annual inspection was dated May 2, 2005, at a tachometer time of 1,923.66 hours. Major repair and alteration records showed that the engine and propeller installation on the aircraft was approved February 6, 1970, in accordance with supplemental type certificate SA686CE. Fueling records, dated March 6, 2006, showed that 63.5 gallons of fuel was sold to N8271D at AND. An excerpt from the airplane's flight manual, in part, stated: ENGINE FAILURE The most probable cause of engine failure would be loss of fuel flow or improper functioning of the ignition system. DISCREPANCY CHECKS (Loss of engine power, loss of fuel flow, rough running engine, etc.) 1. Rough Running Engine a. Mixture - FULL RICH, then lean as required. b. Ignition Switch - CHECK on BOTH position 2. Loss of Power a. Fuel Pressure Gage - CHECK (fuel pressure abnormally low) (1) Mixture - FULL RICH (2) Auxiliary Fuel Pump - ON (3) Auxiliary Fuel Pump - OFF if performance does not improve in a few moments b. Fuel Quantity Indicator - CHECK (Fuel tank being used is empty) (1) Select other tank (check to feel detent)... FUEL SYSTEM ... FUEL CELLS Fuel supply is carried in two bladder-type cells with a total capacity of 20 gallons each, located in the wings just outboard of the fuselage. Usable fuel of each 20 gallon main tank is 17 gallons. ... AUXILIARY FUEL CELLS If installed an additional 19 gallons of usable fuel is available in two auxiliary 10 gallon fuel cells in the wings, outboard of the wheel wells. Both auxiliary cells are connected to a common port in the fuel selector valve, so that both feed simultaneously when the selector valve is set to AUX. The two optional 10-gallon auxiliary tanks may be filled after removing the pressure-type filler caps, located aft and outboard of the main tank filler caps. Do not overfill the tanks. ... FUEL TANK SELECTION The fuel selector valve handle is located forward and to the left of the pilot's seat. Take-offs should be made using the left main tank and landings should be made using the main tank that is more nearly full. In no case should a take-off be made if the fuel indicators are in the yellow band or, with less than 10 gallons of fuel in each main tank. The fuel injection system returns about 10 gallons per hour of excess fuel, fuel return lines are routed through the selector valve to each main cell; except for the auxiliary cells, fuel is returned to the cell from which it is drawn. The auxiliary cells return fuel to the left main cell only. To provide space for the returned fuel from the auxiliary cells, the left main cell should be used to approximately half full before switching to auxiliary. METEOROLOGICAL INFORMATION At 2153, the recorded weather at BIV was: Wind 330 degrees at 5 knots; visibility 10 statute miles; sky condition clear; temperature 1 degree C; dew point -3; altimeter 30.28 inches of mercury. AIRPORT INFORMATION The East Central US Airport/Facility Directory (A/FD) indicated BIV's field elevation was 698 feet above sea level. The A/FD listed one runway, 8/26. The A/FD showed that runway 8/26 was asphalt-surfaced, 6,263 feet long, and 100 feet wide. WRECKAGE AND IMPACT INFORMATION The airplane came to rest upright east of the crest of Ottawa Avenue about 1,700 feet west of runway 8. A trail of four parallel impressions in the mud and snow were observed in the field west of the accident site. The trail started about 56 feet west of the wreckage and led up to the wreckage on about a 080-degree magnetic heading. The trail ended at Ottawa Avenue's west embankment. A dirt, debris, and gravel trail continued across the road from that point to the airplane's resting spot. The trails in the mud and snow were in line with the airplane's landing gear and left tip tank. The airplane's propeller was found separated from the engine about thirty feet east of the airport's perimeter fence inline with the airplane's longitudinal axis. The engine's crankshaft propeller flange separated from the crankshaft and that flange remained attached to the propeller hub. The front cylinders of the engine were impacted in mud. The lower forward cabin area of the fuselage exhibited upward and rearward crushing. An on-scene investigation was conducted. The left and right tip tanks exhibited tears in their fiberglass construction. The left and right auxiliary fuel tanks contained a fluid that exhibited a smell consistent with aviation gasoline (avgas). The left and right main fuel tanks did not contain any fluids. The smell of fuel was present at the accident site. Flight control continuity was established from the flight controls to their respective flight control surfaces. Engine control continuity was established from the cockpit to the engine. The tachometer read 2,037.75 hours. The engine's crankshaft was rotated through the rotation of a gear in its accessory case. Each cylinder produced a thumb compression. The engine's top sparkplugs were removed and they did not exhibit any anomalies. Spark was observed at all top sparkplug leads. Drops of fluid that exhibited a smell consistent with avgas were found in the engine driven fuel pump when it was removed from the engine. Fluid was found in the distribution valve and the fluid exhibited the same smell. The fuel supply line to the engine driven fuel pump was removed from the pump and no fluid was found in that fuel supply line. The fuel tank selector was found in the detent selecting the left main tank. Air pressure was applied to the fuel supply line and air was heard escaping in the left main fuel tank. A bore scope inspection of the left main fuel tank did not reveal any anomalies. Battery power was applied to the electric fuel pump with the fuel selector selecting the left main tank and no fluids were observed exiting the fuel supply line to the engine driven fuel pump. The fuel selector was rotated to the detent for the auxiliary tank, battery power was applied to the electric fuel pump, and a fluid consistent with avgas was observed exiting from the supply line to the engine driven fuel pump. MEDICAL AND PATHOLOGICAL INFORMATION An autopsy was performed on the pilot by the Kent County Medical Examiner's Office. Toxological samples were not taken from the pilot and a FAA Final Forensic Toxicology Accident Report was not produced. TESTS AND RESEARCH The installed EDM 700 engine analyzer was shipped to its manufacturer, JP Instruments, for downloading of its data under National Transportation Safety Board (NTSB) supervision. The data was plotted. The plots are appended to the docket material associated with this case. The engine was shipped to its manufacturer, Teledyne Continental Motors (TCM), for examination. The engine had sustained damage and items were replaced. The induction Y-pipe was crushed and was replaced. Two intake risers were crushed and were replaced. Engine mounts and the starter adapter were broken and were replaced. The mixture control shaft was bent and its O-ring was replaced. The engine driven fuel pump's relief valve cover assembly was crushed and was replaced. A propeller flange and centering pilot shaft were welded to the engine's crankshaft separation point. The engine was test run on May 17, 2006. The engine started and ran up to and at full throttle. The engine's throttle was advanced six times, from idle to full throttle, and the engine accelerated without hesitation. No engine pre-impact anomalies were detected. The TCM engine report is appended to the docket material associated with this case. A representative from Hartzell Propeller inspected the inboard section of propeller blades and hub section on May 16, 2006. All the propeller's mounting studs were intact. After the disassembly, the propeller pitch change rod exhibited no anomalies. A blade pitch change knob was sheared and both shear faces were smeared. No propeller pre-impact anomalies were detected. A governor inspection and test run was performed with a Woodward representative under NTSB supervision at a fixed base operator in Rockford, Illinois. The governor inspection revealed no anomalies and the governor operated during the test run. ADDITIONAL INFORMATION The accident pilot owned a Beech 36, N6222V. He was using the accident airplane while maintenance was performed on his airplane. An excerpt from that airplane's flight manual, in part, stated: FUEL SYSTEM ... FUEL CELLS Either the 44-gallon usable (50-gallon capacity) standard fuel system or the 74-gallon usable (80-gallon capacity) optional fuel system is available. The fuel system consists of a rubber fuel cell in each wing leading edge with a flush type filler cap. A visual measuring tab is attached to the filler neck of the optional system. The bottom of the tab indicates 27 gallons of usable fuel and the detent on the tab indicates 32 gallons of usable fuel in the tank provided the wings are level. The parties to the investigation included the FAA, Hartzell Propeller Inc., and TCM. The aircraft wreckage and retained items were released to an insurance company representative. USEFUL OR EFFECTIVE INVESTIGATION TECHNIQUES The engine's crankshaft propeller flange separated from the crankshaft during impact. When operating, an airplane piston engine requires the load that the propeller produces to preclude the engine from overspeeding the engine's RPM limits and requires the propeller's flywheel effect. Without a flange to mount a propeller, the engine could not be operationally test run. The engine's case was also inspected for damage through the alternator-mounting pad and the starter adapter mounting pad openings. No case damage was observed. Precautions were put in place in the engine run test cell area to preclude non-observing personnel from entering the area surrounding the test cell. Welding the flange and centering pilot shaft on the engine's crankshaft separation allowed a test club propeller to be mounted and the test run to be accomplished.

Probable Cause and Findings

A lossof engine power due to fuel starvation as a result of the pilot's improper fuel system management and failure to select a tank containing fuel. A factor was the dark night conditions.

 

Source: NTSB Aviation Accident Database

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