NTSB CAROL · Event
Event CEN11LA448
Registry · N2332V
FAA Aircraft Registry record.
Make / Model
CESSNA 140
Year of manufacture
1948 · 63 years old at event
Engine
CONT MOTOR C90 SERIES (95 hp)
Seats / Engines
2 seats · 1 engine
Last airworthiness date
19560412
ADS-B equipped
Yes — Mode-S A21657
Registrant of record
MALATO LAWRENCE M
Source: FAA Aircraft Registry (releasable master file).
Aircraft involved
Probable cause & findings
The improper installation of the fuel selector indicator handle, which resulted in a total loss of engine power due to fuel starvation.
Factual narrative
On June 29, 2011, about 1430 central daylight time, a Cessna 140, N2332V, sustained substantial damage during a forced landing after a loss of engine power during the initial climb from runway 11 (4,300 feet by 75 feet, asphalt) at the Burlington Municipal Airport (BUU), Burlington, Wisconsin. The pilot received serious injuries. The airplane was registered to Stick and Rudder LLC and operated by the pilot on a personal flight under the 14 Code of Federal Regulations Part 91. Visual meteorological conditions prevailed at the time of the accident. The flight originated from the Kenosha Regional Airport (ENW), Kenosha, Wisconsin, about 1400. The pilot reported he departed ENW and flew to BUU and did a touch-and-go landing on runway 11. After he started the initial climb from the touch-and-go landing, the engine started to lose power when the airplane was about 100 feet above the runway. The pilot determined that there was not enough runway remaining to land on runway 11. He entered a left turn and attempted to land on runway 19, which was a grass runway, but the airplane impacted the terrain short of the runway. The airplane landed hard on the left wheel and then on the right wheel, which resulted in substantial damage to the airplane. A Federal Aviation Administration airworthiness inspector examined the airplane. The inspection revealed that the fuel selector handle indicated that the right fuel tank was selected. However, the right tank was full of fuel, and the fuel gauge located in the right wing root above the pilot also indicated that the right tank was full. The left fuel tank was empty, and the fuel gauge located in the left wing root above the pilot also indicated that the left tank was empty. The examination of the fuel selector revealed that the fuel selector placard complied with the airplane’s operations manual. However, the inspection revealed that the fuel selector indicator handle was improperly installed. When the fuel selector indicator handle was placed on the right fuel tank, the fuel was actually coming from the left fuel tank. The pilot reported that he departed with the fuel selector set to the right tank, and that he did not switch tanks during the flight. The airplane was purchased by a flying club from a private owner. The private owner reported that he bought the airplane in 1990. The fuel placard that came with the airplane at that time did not comply with the placard found in the airplane’s operations manual. Although the blue/grey colored placard was not the same as the one found in the operations manual, it did work. The previous owner reported that when he was preparing to sell the airplane to the flying club, he decided to make a fuel selector placard that was identical to the one found in the operations manual. He reported that he made the placard and provided it to the mechanic of the flying club so that the mechanic could install it. However, the mechanic at the flying club reported that he did not install the fuel selector placard, and that the previous owner had installed it prior to the airplane being purchased. There was no record in the airplane’s maintenance logbook that indicated when, or by whom, the fuel selector placard was replaced. The pilot held a private pilot certificate with single-engine land and single-engine sea ratings. He reported that he had approximately 4,000 total flight hours with 10 hours in make and model. His last medical was on April 4, 2008, and his last biennial flight review was conducted on September 15, 2008. The pilot indicated on the National Transportation Safety Board’s accident report form that his medical certificate was his “Driver’s License (Sport Pilot only).” The Cessna 140’s maximum gross weight is 1,450 pounds, which exceeds the light-sport airplane maximum gross weight limitation of 1,320 pounds. The pilot reported that he departed with the fuel selector set to the right fuel tank, which was full of fuel. About 30 minutes after departure, he made a touch-and-go landing and takeoff at his destination airport. During the initial climb, the engine started to lose power when the airplane was about 100 feet above the runway. The pilot entered a left turn and attempted to land on an adjacent grass runway, but the airplane impacted the terrain short of the runway. Postaccident examination of the airplane’s fuel system revealed that the left fuel tank was empty and the right fuel tank was full of fuel. Examination of the airplane’s fuel selector revealed that the fuel selector indicator handle was improperly installed. When the fuel selector indicator handle was placed in the right fuel tank position, the fuel was actually coming from the left fuel tank. There was no record in the airplane’s maintenance logbook that indicated replacement of the fuel selector valve, the fuel selector indicator handle, or the fuel selector placard. It was not determined who performed the maintenance on the fuel selector and had improperly installed the fuel selector indicator handle. Source: NTSB Aviation Accident Database Retrieved: 2026-02-12
NTSB Findings
Hierarchical cause / factor breakdown from the FAA bulk avdata database. Each finding tagged C (Cause) or F (Factor).
- C Aircraft-Aircraft systems-Fuel system-Fuel selector/shutoff valve-Incorrect service/maintenance - C
- C Personnel issues-Task performance-Maintenance-Repair-Other/unknown - C
- — Personnel issues-Action/decision-Info processing/decision-Identification/recognition-Pilot
Verbatim from NTSB's published report. Source file
NTSB_2011_CEN11LA448.txt.
Findings + structured fields enriched from FAA avall.mdb.
Full investigation docket on
data.ntsb.gov ↗.
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Related research
What the literature says.
Academic papers and agency reports matching this event's aircraft type or causal vocabulary (stall, fuel starvation, maintenance). Sourced from NASA NTRS, NTSB Safety Studies, FAA CAMI, AOPA Air Safety Institute, Embry-Riddle Scholarly Commons, arXiv, and the Semantic Scholar academic graph.
- Embry-Riddle Scholarly Commons 2023 · Conference paper
The Value of Strong Partnerships to Build a Successful Aviation Maintenance Career Pathway Program for Transitioning Military Service Members
The aerospace industry is competing with other industries for a qualified workforce, and many of those competing industries are investing heavily in creating workforce development pipelines.
- Embry-Riddle Scholarly Commons 2026 · Journal article (IJAAA)
From Reactive to Predictive: A hybrid Trust-Mediated Adoption Framework for Data-Driven Maintenance in Distributed-Authority Aviation Environments
Modern aviation maintenance operates within increasingly data-intensive technological environments, yet the operational integration of predictive maintenance into routine decision-making remains incon…
- NASA NTRS 2026 · Conference Paper
Computational Analysis of Steady State Aerodynamics of Transonic Truss-Braced Wing Configuration in Deep Stall
This study presents a computational investigation of steady state aerodynamics of the Subsonic Ultra-Green Aircraft Research (SUGAR) Transonic Truss-Braced Wing (TTBW) configuration over a wide range …
- Semantic Scholar 2025 · Article (Applied Sciences)
Decision-Making Framework for Aviation Safety in Predictive Maintenance Strategies
The implementation of predictive maintenance (PM) in aviation presents unique challenges due to strict safety requirements, complex operational environments, and regulatory constraints.
- Embry-Riddle Scholarly Commons 2024 · Journal article (JAAER)
Low-Resource Automatic Speech Recognition Domain Adaptation – A Case-Study in Aviation Maintenance
With timeliness and efficiency being critical in the aviation maintenance industry, the need has been growing for smart technological solutions that optimize and streamline the different underlying ta…
- Embry-Riddle Scholarly Commons 2024 · Journal article (JAAER)
A New Trajectory in UAV Safety: Leveraging Reinforcement Learning for Distance Maintenance Under Wind Variations
In the field of aviation, safety is a critical cornerstone, and the operation of Unmanned Aerial Vehicle (UAV) systems is deeply connected with this principle.
Browse the full corpus — academia portal ↗