Pilot Debrief

BEECH B23 near Ocean Isle Beach, NC — 2017-06-28

Final reportERA17LA215
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Date
2017-06-28
Location
Ocean Isle Beach, NC, USA
Airport
60J
Aircraft
BEECH B23
Registration
N4023T
Category
Airplane
Highest injury
Serious
Fatalities
0
Phase of flight
Initial climb

Probable cause

The pilot's improper positioning of the fuel selector between the left and right fuel tank positions, which resulted in a partial loss of engine power due to fuel starvation and a subsequent forced landing into trees.

NTSB narrative

The private pilot reported that, before the accident flight, he had conducted a cross-country, personal flight uneventfully with the fuel selector positioned to the left fuel tank. After landing, the pilot added 15 gallons of fuel to the left tank and about 5 gallons of fuel to the right tank. The passenger reported that, before the return flight, the pilot told him that he was going to use the right fuel tank for the return flight. Engine start, taxi, engine run-up, and takeoff were normal. The pilot reported that, when the airplane reached about 500 ft mean sea level, he noticed that the airplane was not climbing as expected and that the engine rpm had reduced to less than 2,000. He added that, as he started a "slow bank" left turn back toward the airport, the airplane would no longer climb. He considered switching fuel tanks but chose not to because the engine was developing some power and he was concerned switching tanks might cause a total loss of power. Once the pilot realized that the airplane would not reach the runway, he conducted a forced landing into a wooded area. During the landing, the left wing struck a tree, and the airplane then came to rest inverted. Both wings sustained substantial damage. Examination of the airframe and engine revealed that the fuel selector was positioned halfway between the left and right tank positions; no other preaccident mechanical malfunctions or failures were found that would have precluded normal operation. It is likely that the midrange position of the fuel selector led to the engine being starved of fuel, which resulted in a partial loss of engine power.

Analysis

Primary failure mode
Fuel management
First missed decision gate
Pilot considered switching fuel tanks but chose not to.

NTSB coding

Evidence available

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

Docket documents11

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