N543JL

HISTORY OF FLIGHT

On September 21, 1997, at 1034 hours Pacific daylight time, a Beech C23, N543JL, collided with a commercial office building after takeoff from Zamperini Field, Torrance, California. The airplane was destroyed. The certificated private pilot and three passengers received fatal injuries. The airplane was operated as a personal flight by the pilot under the provisions of 14 CFR Part 91. The flight was originating from runway 29R and was destined for the Catalina Airport, Avalon, California. Visual meteorological conditions prevailed and no flight plan was filed.

Several witnesses were interviewed. One pilot/witness reported that he saw the airplane as he was driving to the airport. He observed the airplane depart at "an extremely low altitude, approximately 150 to 200 feet agl." He continued to watch the airplane and noted that he would be crossing under its flight path. The witness stated that "the elevator appeared to be in an extremely high position given the slow speed and altitude of the aircraft. The engine was not missing or making any irregular noises . . . . I immediately assumed he was grossly overweight. At this point I knew the pilot was in trouble." He looked over his shoulder to see where the airplane was headed and noticed a cloud of black smoke. He drove over and found that the airplane had collided with the office building.

Another witness reported that he first noticed the accident airplane flying westbound just after takeoff. He stated, "the tail of the plane was low in relation to the front of the plane. It was at that time I did not think the plane was going to stay in the air much longer." The airplane disappeared from his view due to surrounding buildings. He then saw smoke rising from an office complex. The witness reported that he later realized why the airplane had first captured his attention. He stated, "I watched about a dozen other planes take off and they were all at a higher altitude at the same point where I first observed the plane that crashed."

One other pilot/witness had been on a helipad waiting for a takeoff clearance at the time of the accident. He stated that the takeoff roll and initial rotation appeared normal, but when the airplane reached approximately 100 feet agl, it began to pitch up. He reported that the "pitch attitude was so high that I could clearly see the top of his wings." The airplane never seemed to gain altitude, but then banked to the right about a 20- to 30-degree bank angle. A few seconds later the witness observed a black cloud of smoke from the building area.

The local controller reported that the pilot had requested a straight-out departure from runway 29R. The controller suggested that the pilot perform a "right forty-five departure . . . for noise abatement reasons." He observed the airplane takeoff and cross the departure end of the runway. He then observed smoke about 1/4 mile west/northwest of the airport.

PERSONNEL INFORMATION

According to the Federal Aviation Administration (FAA) Airman Certification database, the pilot held a private pilot certificate with an airplane single engine land rating, as well as an instrument airplane rating. The original date of issuance for the private pilot certificate was May 07, 1985. According to the FAA Aeromedical Certification Division, the pilot held a third-class medical, dated October 22, 1996, with the noted restriction that he must wear corrective lenses.

The FAA Airman Certification database revealed that none of the passengers had ever held FAA airman certificates.

AIRCRAFT INFORMATION

A mechanic at the fixed-base operator (FBO) was interviewed. He reported that on Saturday, September 20, 1997, the accident pilot had planned to fly to Catalina Island with three passengers. The pilot left the FBO and returned some time later. He informed the mechanic that during the engine run-up at 2,000 rpm, with the parking brake set, the airplane "rotated" around the left brake, so he elected to return. The mechanic explained some of the possible causes of the problem and asked the pilot to bring the airplane back on Monday, September 22, 1997, since the shop was closed on the weekend.

According to the airplane's maintenance logbooks, the aircraft had last received an annual inspection on December 19, 1996. On the annual/100-hour inspection form, the engine static rpm was recorded as 2,200 rpm. The airplane's Pilot Operating Handbook (POH) lists the static rpm limits as 2,250 to 2,350 rpm. No corrective actions were noted on the inspection form. The mechanic who performed the inspection reported that he determined the aircraft to be in an airworthy condition.

Current weight and balance values were not obtained for the airplane. The delivery weight and balance values were used in calculating the airplane's accident gross weight and center of gravity (CG). The autopsy weights were used for the occupant weights. Three different weight and balance calculations were performed, since the occupant positions were not determined. A fuel loading of 50 gallons was used, based on a witness statement. According to the Beech representative, the weight and balance calculations showed that the airplane was near gross weight at takeoff, and the CG could have been as far forward as 114.09 inches, which is forward of the forward limit, or the CG could have been as far aft as 115.93 inches, which is a midrange CG value.

WRECKAGE AND IMPACT

The accident site was in a medical business park located north of the runway 29R extended centerline, and about 2,000 feet from the departure end of the runway. The airplane penetrated the third and second floors of the building, and came to rest inverted suspended in a hole in the first floor ceiling.

The empennage and the right wing were draped over a balcony railing, the left wing was inside the second floor office, and the fuselage was hanging from the first floor ceiling into the office directly below. Fire nearly consumed the fuselage, the left wing, and the first and second floor offices. The office sprinkler system flooded the remaining offices in the building.

The engine was observed lying inverted and lodged between the structure of the first and second floor of the office building. The two-bladed fixed pitch propeller remained attached at the crankshaft. The engine displayed thermal damage. Initial examination of the engine while still entangled with the attached wreckage did not reveal any evidence of catastrophic mechanical malfunction.

The left wing from the aileron outboard was consumed by fire. The flap remained attached to the wing. The wing fuel tank was consumed by fire. The aileron was not observed. The aileron flight control cables were continuous from the aileron bell crank attach fittings into the cabin.

The right wing was separated from the fuselage. The main spar was separated adjacent to the center wing spar splice and at the main landing gear strut. The inboard half of the flap remained attached to the wing, and the outboard half of the flap was consumed by fire. The wing fuel tank was consumed by fire. The outer 9 feet of the wing were separated from the airplane. The aileron remained attached to the outer wing panel. The aileron control cables remained attached to the aileron bell crank. The control cables were separated at the accident site by the recovery crew.

The fuselage sidewalls were consumed by fire. The lower cockpit and cabin floor area was partially consumed by fire. The cabin roof was separated from the fuselage and partially consumed by fire. The cockpit flight controls were intact from the cockpit aft to about FS 181, where they had been cut during the recovery process. The pitch trim mechanism was found melted and fused to the remains of the COMM Select Panel. The manual flap handle mechanism was examined. There was no evidence that the flap latch had been engaged in any of the three position notches. The flap extend cable was separated. The flap arm was separated on the right side.

One of the propeller blade tips remained straight, and the opposite blade tip was bent with a slight aft curl.

The fuel selector valve, airframe fuel strainer (gascolator), and fuel boost pump were removed as an assembly. The gascolator was clear. The output fuel line check valve was installed in the proper direction. The fuel boost pump pumped fuel when energized.

The control column was found positioned forward, against the firewall. The instrument panel was consumed by fire. The bottom fitting of the control column with the two pitch cables attached was found punched through the belly of the airplane. Neither control yoke assembly was found.

The empennage structure was partially consumed by fire. The empennage flight control surfaces could be manipulated by the control cables. The pitch trim actuator could be manipulated through the trim cables. An electric pitch trim servo was installed. During the examination, the pitch trim servo was energized and would operate in both directions.

The cabin area and occupant restraint systems were examined after the occupants were extracted and the airplane was recovered. Three engaged seat belt buckles were found. The four shoulder harness guides mounted along the cabin roof were found attached to the cabin roof structure.

TESTS AND RESEARCH

A teardown inspection of the engine was performed at Aircraft Recovery Services, Compton, California, following recovery.

The propeller was removed to facilitate the examination. The top and bottom spark plugs were removed and examined. The rocker box covers and the rear mounted accessories were removed. The rocker assemblies, springs, and valve retainers were secure at each cylinder assembly. The four cylinder assemblies were removed and examined. The cylinder combustion chambers were undamaged and the valves were intact. There was no evidence of valve to piston...