Pilot Debrief

BEECH 95-C55 near Ulysses, PA — 2011-11-17

Final reportERA12FA074
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Date
2011-11-17
Location
Ulysses, PA, USA
Aircraft
BEECH 95-C55
Registration
N54552
Category
Airplane
Highest injury
Serious
Fatalities
0
Phase of flight
Cruise

Probable cause

The total loss of left engine power due to fuel starvation, and the pilot’s improper configuration of the fuel system during remedial actions, which resulted in fuel starvation of the right engine. Contributing to the accident was the pilot’s incomplete preflight inspection and the pilot’s operation of the airplane with a known faulty fuel quantity indicating system.

Contributing factors

Contributing to the accident was the pilot’s incomplete preflight inspection and the pilot’s operation of the airplane with a known faulty fuel quantity indicating system.

NTSB narrative

The airplane departed on a cross-country flight with an unknown quantity of fuel. Although the pilot had asked for the main tanks to be filled, it is likely that the fueler did not add enough fuel. According to the pilot, the left main fuel gauge read inaccurately, but the pilot did not check the fuel level during his preflight inspection. Given the flight times since the airplane’s last complete fuel service, its subsequent partial fuel service, and the fuel consumption rates provided by the airplane’s owner, it is likely that the fuel supply in the left main tank was nearly exhausted during the climb after takeoff from the departure airport on the accident flight. The airplane completed the cruise portion of the flight on the auxiliary tanks, and when the fuel selectors were placed back in the main positions, the left engine stopped producing power due to fuel starvation. According to the pilot’s operating manual, the left fuel selector should have been in the main or auxiliary position, and the right fuel selector should have been in the crossfeed position. However, during the left-engine restart attempt, the pilot configured the left fuel selector to crossfeed position and the right fuel selector to the auxiliary position; such a configuration starved the right engine of fuel. When the right engine “surged,” the pilot abandoned the restart and feathered the left propeller. Restart of the right engine was also unsuccessful, and the pilot completed a power-off forced landing. The airplane’s emergency procedures and fuel system schematics revealed that, had the left engine been feathered and the fuel system configured properly by the published procedure, the right engine would have continued to operate on the fuel that remained in the right main fuel tank.

Analysis

Primary failure mode
Fuel management
First missed decision gate
Pilot should have confirmed fuel levels before departure from ILG.

NTSB coding

Evidence available

  • Photos
  • 19 docket documents
View NTSB final reportView NTSB docket

Docket documents19

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