Aircraft Accident/Incident Report

Knoxville, Tennessee 37901
Thursday, March 16, 1989 16:00 EST

NTSB Narrative Summary Released at Completion of Accident

IT WAS REPORTED THAT THE PILOT/OWNER AND THE PAX HAD SPENT THE DAY INSTALLING AN AIR-OIL SEPARATOR KIT ON THE AIRPLANE. AFTER THE INSTALLATION BY THE TWO UNCERTIFICATED MECHANICS, THEY DEPARTED THE LOCAL ISLAND AIRPORT SOMETIME AFTER 1500 EDT. AT ABOUT 1605, THE AIRPLANE WAS OBSERVED TO LAND ON THE RIVER SHORT OF THE AIRPORT SURFACE. BOTH OCCUPANTS EXITED THE AIRPLANE AND SWAM TOWARD SHORE. THE PILOT MADE IT TO SHORE BUT HIS PAX WAS HAVING PROBLEMS SO HE SWAM BACK OUT TO HELP. BOTH OCCUPANTS SANK IN THE 48 DEGREE WATER AND THEIR BODIES WERE RECOVERED LATER. AFTER RECOVERY, THE ENGINE WAS DRIED OUT AND A TEST RUN PERFORMED. SOME CONTAMINATION WAS FOUND IN THE PRESSURE CARBURETOR. THE ENGINE HAD A HISTORY OF STOPPING ON THE GROUND.

NTSB Probable Cause Narrative

THE PILOT'S CONTINUED OPERATION OF THE AIRPLANE WITH A KNOWN MECHANICAL DEFECT IN THE ENGINE CARBURETOR/FUEL SUPPLY SYSTEM AS EVIDENCED BY THE PAST HISTORY OF ENGINE STOPPAGE DURING GROUND OPERATION. CONTRIBUTING TO THE ACCIDENT WAS THE PILOT'S PERFORMANCE OF UNAUTHORIZED MAINTENANCE ON THE AIRCRAFT AND ITS SYSTEM.

Event Information

Type of Event Accident
Event Date 3/16/1989
Event Day of the Week Thursday
Time of Event 1600
Event Time Zone Eastern Standard Time
Event City KNOXVILLE
Event State TENNESSEE
Event Country --
Zipcode of the event site 37901
Event Date Year 1989
Event Date Month 3
MidAir Collision Indicator No
On Ground Collision occurred ? No
Event Location Latitude
Event Location Longitude
Event Location Airport
Event Location Nearest Airport ID
Indicates whether the acc/inc occurred off or on an airport Off Airport/Airstrip
Distance from airport in statute miles 0
Degrees magnetic from airport 0
Airport Elevation 833
Weather Briefing Completeness Unknown
Investigator's weather source Weather Observation Facility
Time of the weather observation 1550 Eastern Standard Time
Direction of event from weather observation facility (degrees) 215
Weather Observation Facility ID TYS
Elevation of weather observation facility 981
Distance of event from weather observation facility (units?) 9
Time Zone of the weather observation EST
Lighting Conditions Day
Lowest Ceiling Height 0
Lowest Non-Ceiling Height 25000
Sky/Lowest/Cloud Conditions Thin Overcast
Sky Condition for Lowest Ceiling None
Visibility Runway Visual Range (Feet) 0
Visibility Runway Visual Value (Statute Miles) 0
Visibility (Statute Miles) 15
Air Temperature at event time (in degrees celsius) 19
Dew Point at event time (in degress fahrenheit) -1
Wind Direction (degrees magnetic) 20
Variable Wind Indicator Unknown
Wind Speed (knots) 10
Wind Velocity Indicator Unknown
Wind Gust Indicator Not Gusting
Wind Gust (knots) 0
Altimeter Setting at event time (in. Hg) 30
Density Altitude (feet) 1200
Intensity of Precipitation Unknown
METAR weather report --
Event Highest Injury Fatal
On Ground, Fatal Injuries 0
On Ground, Minor Injuries 0
On Ground, Serious Injuries 0
Injury Total Fatal 2
Injury Total Minor --
Injury Total None --
Injury Total Serious --
Injury Total All 2
Investigating Agency NTSB
NTSB Docket Number (internal use) 727
NTSB Notification Source --
NTSB Notification Date Mar 16 1989 12:00AM
NTSB Notification Time 1850
Fiche Number and/or location -used to find docket information 40231
Date of most recent change to record Dec 13 2000 12:31PM
User who most recently changed record dbo
Basic weather conditions Visual Meteorological Cond
FAA District Office --

Aircraft Involved

Aircraft #1

Aircraft Registration Number N5403D
NTSB Number ATL89FA106
Missing Aircraft Indicator N
Federal Aviation Reg. Part Part 91: General Aviation
Type of Flight Plan filed None
Flight plan Was Activated? --
Damage Substantial
Aircraft Fire None
Aircraft Explosion None
Aircraft Manufacturer's Full Name BEECH
Aircraft Model H35
Aircraft Series Identifier H35
Aircraft Serial Number D-4873
Certified Max Gross Weight 2900
Aircraft Category Airplane
Aircraft Registration Class U.S. Registered/U.S. Soil
Aircraft is a homebuilt? No
Flight Crew Seats --
Cabin Crew Seats --
Passenger Seats --
Total number of seats on the aircraft 4
Number of Engines 1
Fixed gear or retractable gear Retractable
Aircraft, Type of Last Inspection Annual
Date of Last Inspection Sep 2 1988 12:00AM
Airframe hours since last inspection 66
Airframe Hours 3602
ELT Installed Yes
ELT Activated No
ELT Aided Location of Event Site No
ELT Type --
Aircraft Owner Name ROBERT M MELIA
Aircraft Owner Street Address 2108 LAKEPOINT AVE.
Aircraft Owner City KNOXVILLE
Aircraft Owner State TN
Aircraft Owner Country
Aircraft Owner Zipcode 37922
Operator is an individual? --
Operator Name W. T. CHRISTIAN
Operator Same as Owner? No
Operator Is Doing Business As --
Operator Address Same as Owner? No
Operator Street Address 8503 WESTLAND DR.
Operator City KNOXVILLE
Operator State TN
Operator Country
Operator Zip code 37923
Operator Code
Owner has at least one certificate None
Other Operator of large aircraft? No
Certified for Part 133 or 137 Operation Unknown
Operator Certificate Number --
Indicates whether an air carrier operation was scheduled or not --
Indicates Domestic or International Flight --
Operator carrying Pax/Cargo/Mail --
Type of Flying (Per_Bus / Primary) Personal
Second Pilot on Board Yes
Departure Point Same as Event Yes
Departure Airport Code
Departure City
Departure State
Departure Country
Departure Time 0
Departure Time Zone
Destination Same as Local Flt dest & departure same, accident can occur anywhere
Destination Airport Code
Destination City
Destination State
Destination Country
Specific Phase of Flight Descent
Report sent to ICAO? --
Evacuation occurred --
Date of most recent change to record Jan 2 2001 10:30AM
User who most recently changed record dbo
Since inspection or accident --
Event Location Runway Number and Location 0
Runway Length 0
Runway Width 0
Sight Seeing flight No
Air Medical Flight No
Medical Flight --