NTSB Identification: CHI94FA076.
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Accident occurred Sunday, February 06, 1994 in CHESTERFIELD, MO
Probable Cause Approval Date: 01/12/1995
Aircraft: BEECH 95, registration: N9903R
Injuries: 2 Fatal.
NTSB investigators either traveled in support of this investigation or conducted a significant amount of investigative work without any travel, and used data obtained from various sources to prepare this aircraft accident report.
ON DOWNWIND TO LAND, BOTH ENGINES LOST POWER DUE TO FUEL STARVATION. CONTROL OF THE AIRPLANE WAS NOT MAINTAINED AND THE AIRPLANE IMPACTED IN AN OPEN CLEARING AT A STEEP ANGLE. THE FUEL SELECTOR VALVE HANDLES INDICATED OPPOSITE (180 DEGREES OUT) OF THE ACTUAL FUEL VALVE POSITION SELECTED. NO FUEL WAS EVIDENT IN THE LEFT AUXILIARY TANK AND THERE WAS EVIDENCE OF FUEL IN THE OTHER 3 TANKS. NO INDICATION OF FUEL OR PROPELLER ROTATION WAS FOUND AT THE LEFT ENGINE. FUEL AND SOME ROTATION WAS EVIDENT AT THE RIGHT ENGINE. NEITHER PROP WAS FEATHERED, FLAPS WERE UP AND LANDING GEAR WAS DOWN. THE MANDATORY SERVICE BULLETIN (MSB) RECENTLY INSTALLED INVOLVING THE FUEL SELECTOR VALVE HANDLES COULD NOT BE PERFORMED AS PER THE INSTRUCTIONS. THE MECHANIC MODIFIED THE KIT PROCEDURES, RESULTING IN THE SELECTOR HANDLES BEING INSTALLED OPPOSITE OF THE FUEL PORT POSITION.
The National Transportation Safety Board determines the probable cause(s) of this accident to be: incorrect installation of the fuel selector valves during mandatory service bulletin modification which resulted in fuel starvation to both engines and failure of the pilot-in-command to maintain aircraft control during emergency descent. A factor was inadequate quality control prior to publication of the mandatory service bulletin. Full narrative available
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