NTSB Factual Report

History of Flight

On October 7, 1995, at 1212 hours mountain standard time, a Beech A-36, N3066W, lost power and crashed while making a low pass over runway 01 at the Mesquite Airport, Mesquite, Nevada. The crash site is at Beaver Dam, Arizona, about 1/2 mile north-northeast of Mesquite Airport. The pilot was completing a visual flight rules air race. The airplane, registered to and operated by the pilot, was destroyed. The certificated commercial pilot and the two passengers (the right seat passenger was doing navigation duties and held a private pilot certificate) sustained fatal injuries. Visual meteorological conditions prevailed. The flight originated at Van Nuys Airport, Van Nuys, California, at 0946 hours.

Race officials told National Transportation Safety Board investigators that the pilot was participating in the Valley Air Derby air race sponsored by the Van Nuys Chapter of the 99's - a lady pilot organization. The officials said that air race participants were required to fly over various airports until reaching Mesquite Airport, the race ending airport.

The consensus of the ground witnesses was that the pilot was flying over runway 01 at Mesquite Airport at 200 feet above ground level (agl) at a high rate of speed. The engine backfired and sputtered momentarily. When the airplane was over the departure end of the runway, it began to oscillate about the lateral axis (nose up and down). It then entered a right banking turn and nosed down. Moments later, the witnesses saw a cloud of dirt rising from the crash site.

Some ground witnesses reported seeing a "vapor trail" or exhaust gasses emanating from the airplane. Other witnesses said that the airplane's nose pitched up during the right turn and described the rapid descent as a stall.

The accident coordinates are: 38 degrees, 50.10 minutes north latitude and 114 degrees, 03.31 minutes west longitude.

Crew Information

First Pilot

The first pilot (occupying the left front seat) held a commercial pilot certificate with airplane single-engine land and instrument airplane ratings. She also held a third-class medical certificate dated February 1, 1995; the certificate contained a "must have glasses available for near vision" limitation endorsement.

Safety Board investigators recovered one of the pilot's flight hours logbook. The initial logbook entry was made on November 22, 1992, and the last entry was made on October 2, 1995. The logbook flight hours entries corresponded with the airplane's hobbsmeter until the hobbsmeter failed. The entries then corresponded with the tachometer hourmeter.

The flight hours listed on page 3 of this report were obtained from the referenced logbook and the pilot's last medical application form. The pilot showed on the last medical application form that she accrued 3,200 hours. The logbook entries after February 1, 1995, show that the pilot logged 95 flight hours. The combined flight hours indicate that the pilot accrued 3,295 hours, of which at least 308 hours were flown in the accident airplane. During the preceding 90 days of the accident, the pilot accrued 33 hours.

The pilot satisfactorily completed a biennial flight review (BFR) as required by 14 CFR 61.56 on November 11, 1993. The BFR was flown in the accident airplane. She also complied with the general recency experience requirements of current federal air regulations

Right Front Seat Passenger

Race officials told investigators that the race rules require a second pilot or navigator. The right front seat passenger was the navigator.

The right front seat passenger held a private pilot certificate with an airplane single-engine land, multiengine land, and instrument airplane ratings. FAA records show that the certificate was issued to the pilot based on a foreign (British) pilot certificate and a special medical flight test. The pilot received his last third-class medical certificate on July 30, 1990; the certificate contained a "must have available glasses for near vision limitation endorsement." A third-class medical certificate is valid for 24 calendar months.

Safety Board investigators found the passenger's flight hours logbook. The initial entry was made on January 15, 1984; the last entry was dated July 25, 1989. The logbook examination showed that the passenger carried forward 6,149.2 hours from previous flying.

The logbook examination also showed that the pilot accrued 6,154.8 hours. He accrued 627.8 hours in single-engine airplanes, of which 25.4 hours were flown in the accident airplane [6.3 hours as pilot-in-command (PIC) and 19.1 hours as second-in-command (SIC)]. The remaining flight hours were logged in multiengine airplanes.

According to current federal air regulations, a pilot cannot log any SIC flight time unless the airplane type certificate requires two pilots. If the flight is conducted under 14 CFR Part 135 or Part 121 and the operations specifications require two pilots, a pilot can log SIC flight time. The Beech A-36 does not require two pilots and the flight was conducted under 14 CFR Part 91.

The passenger's last BFR was accomplished on December 13, 1988. The BFR was flown in a Cessna 152.

Aircraft Information

Safety Board investigators recovered the airplane's maintenance logbooks (airframe, engine, & propeller) at the accident site. The airframe logbook examination showed that the last annual inspection was accomplished on the airframe and engine on July 14, 1995. The airplane accrued 4,838.36 hours at the time of the inspection (1,604.56 hours on the recording tachometer hourmeter). The airplane accrued 33 hours since the inspection at the time of the accident. There were no fuel system problems noted in the logbook.

A maintenance facility installed the "zero time" factory remanufactured engine on the airplane on February 13, 1992, according to a supplementary type certificate (STC) SA2682NM. The engine was installed at a tachometer hourmeter time of 1,076.34 hours. The engine accrued 528.22 hours at the time of the inspection and 560.74 hours at the time of the accident.

The fuel injector nozzles were cleaned at the time of the inspection.

The propeller was overhauled on March 29, 1994. All new blades were installed when it was overhauled. The propeller was installed at a tachometer hourmeter reading of 1,475.0 hours. The propeller accrued 162.08 hours at the time of the accident.

According to the Beech A-36 Pilots Operating Handbook (POH) before starting checklist, the pilot should check the fuel valve operation and "select tank more nearly full." The before landing checklist requires the pilot to "select tank more nearly full."

The airplane was equipped with the 80-gallon capacity (74-gallon usable) optional fuel system. According to the POH fuel system description and schematic, the fuel vapor return line is routed through the fuel selector which routes the unused return fuel to the selected tank. Each wing is equipped with a fuel anti-siphon check valve.

The POH engine failure checklist states, in part:

Landing straight ahead is usually advisable. If sufficient altitude is available for maneuvering, accomplish the following:

1. Fuel Selector Valve - SELECT OTHER TANK (Check to feel detent) 2. Auxiliary Fuel Pump - ON 3. Etc...

The following notation is listed:

The most probable cause of engine failure would be loss of fuel flow, improper functioning of the ignition system, or blockage of the induction system.

If No Restart

1. Select most favorable landing site. 2. See EMERGENCY LANDING procedure 3. The use of landing gear is dependent on the terrain where landing must be made.

Meteorological Information

Mesquite Airport does not have any weather observation facilities. The weather data reflected on page 4 of this report were obtained from the ground witnesses.

McCarran Airport, Las Vegas, Nevada, is the nearest surface weather observation facility and is about 77 miles south of Mesquite Airport. The 1256 hours surface weather observation was:

Clear below 12,000 feet; visibility - 10+ miles; temperature - 74 degrees F; dew point - 26 degrees F; Surface winds - calm; altimeter setting - 29.92 inHg.

Fire

There was no pre- or postimpact fire.

Wreckage and Impact Information

Ground scars and the wreckage examination disclosed the airplane struck the ground in a nose-down and about a 60-degree right wing down attitude. The top of the cabin was facing about 30 degrees at impact. The airplane came to rest, right-side-up, about 45 feet southeast of the initial impact point facing 205 degrees. Investigators also found an empennage ground imprint between the initial impact point and the airplane final resting point.

All of the airplane's major components and flight control surfaces were found at the main impact area. Both wings and all of the flight controls remained attached at their respective wing-to-fuselage attach fittings.

The flight controls could not be operated by their respective control mechanisms due to impact damage. Continuity of the flight control cables to the cabin-cockpit area was established.

The right wing was found bent upward about 60 degrees. The leading edge and forward spar exhibited downward crushing signatures.

The inboard section of the left wing leading edge was found crushed upward. The leading edge, outboard of the fuel tank, was also crushed upward.

Both wing flaps were found retracted. The wing flap actuator jackscrew was found extended 1 11/16 inches. According to a Raytheon Aircraft Company (formerly Beech Aircraft Company) representative, this extension corresponds to a flap retracted position.

The nose landing gear separated from its attach point and was found next to the engine compartment. Both landing gears were found partially extended. The landing gear motor actuator was found near the retracted position; the landing gear control switch was found in the retracted position. The landing gear over-center locking mechanism was broken on the left side.

The empennage was found intact. The elevator trim tab actuator was found extended 1 3/16 inches. According to the Raytheon representative, this setting corresponds to a 5-degrees tab up (nose down) setting. The lower fuselage, aft of the rear cabin bulkhead, displayed buckling signatures.

The cockpit area was extensively compromised. The right front doors were removed by rescue personnel. The throttle, mixture, and propeller controls were found in the full in position. These controls are a vernier type.

The right rudder pedals were found in the stowed position.

Both main wing fuel tanks were ruptured. Fuel odor permeated the ground under the main fuel tanks. The unmetered fuel line between the engine firewall and the engine driven pump contained less than a teaspoon of fuel. The fuel line between the engine driven pump and the fuel control unit did not contain any fuel. Both of these lines were intact and did not sustain any impact damage.

Investigators did not find any fuel stains on either wing, fuselage, or empennage.

The engine remained partially connected to the firewall, but was found on its left side. The engine crankshaft rotated freely. Continuity of the engine gear and valve train assembly was established and thumb compression was noted during rotation of the crankshaft.

Both magnetos produced spark upon rotation of the crankshaft.

The upper spark plugs were free of any carbon deposits and their center electrodes showed minimal ovaling signatures. The Nos. 2, 4, and 6 spark plugs were oil soaked.

The propeller assembly remained attached at the engine crankshaft. The No. 1 (marked for identification purposes only) blade was bent about 80 degrees toward the face side; the bending began at midspan. The blade exhibited some chordwise scuffing and the outboard section was polished. No "S" twisting signatures were observed.

The No. 2 blade displayed minimal "S" twisting and chordwise scuffing signatures; the blade was bent toward the face side about 20 degrees.

The No. 3 blade was found impaled in the dirt. The blade was twisted toward a high pitch angle. The blade did not exhibit any chordwise scuffing, leading edge gouging, or "S" twisting signatures.

On October 13, 1995, Safety Board investigators completed the examination of the wreckage at Air Transport, Phoenix, Arizona.

Fuselage Fuel System

The fuel selector valve was found selected to the right wing tank position which corresponded to the fuel selector valve handle setting. The selector valve contained about 2 ounces of fuel. The fuel was free of contaminates and its screen was properly installed.

Air was introduced to the selector valve and was unrestricted through the right and left tank valve settings. The main fuel lines from the wings to the fuel selector valves were unrestricted. Both wing fuel inlet screens were free of contaminates.

Right Wing Fuel System

Air Transport personnel reported that the when they removed the right wing they did not observe any fuel.

The main fuel bladder tank was found punctured near the right rear lower side. This puncture was next to a lower side wing punctured area. The forward inboard section of the bladder was also torn. This area sustained impact damage. There were no fuel stains on the metal surfaces next to the bladder tank or the punctured areas.

The fuel vent check valve was intact and not damaged. The check valve operated normally.

Left Wing Fuel System

Air Transport personnel reported that the left wing contained about 2 gallons of fuel.

The main fuel bladder tank was punctured on its upper leading edge side. No fuel stains were observed on the metal surface next to the bladder tanks or the torn area.

The fuel vent check valve was intact and not damaged. The check valve operated normally.

Engine Driven Fuel Pump

The engine-driven fuel pump drive gear was found intact. The pump produced pressure when its drive gear was rotated.

The fuel metering unit throttle valve was found seized in the full open position. The metering unit sustained impact damage and was broken from its attach points.

Medical and Pathological Information

The Mohave County Coroner's Office, Kingman, Arizona, conducted a post mortem examination on the pilot. The pathologist did not report that the pilot suffered from any condition or disease which would adversely affect her ability to perform her duties.

The FAA, Civil Aeromedical Institute (CAMI), conducted toxicology examinations on the pilot. The toxicologist reported that the examinations were negative for alcohol or drugs. The examination, however, showed a positive amount of chlorpheniramine, a drug most often used in over-the-counter medications.

Tests and Research

Safety Board investigators were unable to extract any data from the airplane's fuel computer.

Additional Information

The wreckage, except the fuel computer, ARNAV System, Inc., Model FC-10, serial number 010463, was released to the Air Transport on October 13, 1995. The fuel computer was returned to the airplane insurers on October 14, 1995.

NTSB Probable Cause

The pilot's improper use of the fuel selector valve, which resulted in fuel starvation; and her failure to maintain adequate airspeed while maneuvering, which resulted in an inadvertent stall.