NTSB Identification: LAX05LA305.
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Accident occurred Monday, September 19, 2005 in Bisbee, AZ
Probable Cause Approval Date: 08/29/2006
Aircraft: Beech 35-C33, registration: N5757D
Injuries: 3 Uninjured.

NTSB investigators may not have traveled in support of this investigation and used data provided by various sources to prepare this aircraft accident report.

The airplane settled back to the ground during the takeoff initial climb and collided with bushes and desert terrain off the end of the runway, bending the right wing and aft carry-though spars. The airport was at an elevation of 4,780 feet mean sea level (msl) and the density altitude was 6,692 feet msl. During his leaning of the mixture, the pilot set the rpm at 1,800, leaned the mixture for an increase in rpm, then richened the mixture by one full turn, all in accordance with instructions given him during his check-out in the rental airplane by a flight instructor. The pilot completed his pre-takeoff checklist, made a traffic advisory, and positioned the airplane for takeoff. He held the brakes and applied full throttle. As the rpm came up to 2,600 rpm, the engine sounded normal, the brakes were released, and he began the takeoff roll. During the takeoff ground roll, a significantly greater distance was required to develop airspeed than the pilot expected; however, he thought this to be the result of the airport elevation and the outside air temperature. The pilot operating handbook (POH) performance charts showed that a ground roll of 2,100 feet should have been required to achieve takeoff over a 50-foot obstacle. The airplane reached 65 knots approximately 2/3 down the 5,929-foot-long runway and slight elevator back pressure was applied. The airplane lifted off and back pressure was eased to remain in ground effect and continue airspeed acceleration. However, the airplane did not accelerate, but instead settled back to the ground. The airplane touched down just off the end of the runway and came to a stop approximately 20 feet from the airport perimeter fence. The day prior to the accident, the pilot was checked out in the airplane. Following the check-out flight, he asked the certified flight instructor (CFI) the proper leaning procedures for the airplane. He was told to lean the mixture at run-up (1,800 rpm) using engine rpm, and then richen it one full turn at field elevations below 5,000 feet msl, and to lean the mixture at full power using the exhaust gas temperature gauge at field elevations above 5,000 feet msl. The POH states that the engine should be leaned using 2,600 rpm using the combined manifold and fuel flow indicator gauge. This gauge shows fuel flow in gallons per hour and is marked with a green arc to indicate normal fuel flow operating parameters for different power settings. The takeoff optimum fuel performance range is covered by green sectors and the high side of each green sector represents the appropriate fuel setting required to obtain maximum power when operating at full throttle and 2,600 rpm. A Federal Aviation Administration inspector test-ran the engine following the accident and no operational anomalies were noted.

The National Transportation Safety Board determines the probable cause(s) of this accident to be:

the pilot's failure to lean the mixture in accordance with the pilot operating handbook specified procedures, which resulted in a power deficiency, a degraded climb capability, and the inability to attain/maintain an adequate airspeed that led to a stall/mush condition while departing in high density altitude conditions. The pilot's failure to abort the takeoff when an excessive takeoff ground roll became apparent was also causal. Also causal, was the certified flight instructor's failure to provide the proper leaning procedures during a preflight briefing.

Full narrative available

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