Manual
2100-510E
Page
35 of 38
GROUND SOURCE HEAT PUMP
PERFORMANCE REPORT
This performance check report should be filled out by installer and retained with unit.
DATE
TAKEN BY:
1.
UNIT:
Mfgr
Model No.
S/N
THERMOSTAT:
Mfgr
Model No.
P/N
2.
Person Reporting
3.
Company Reporting
4.
Installed By
Date Installed
5.
User’s (Owner’s) Name
Address
6.
Unit Location
WATER SYSTEM INFORMATION
7.
Open Loop System (Water Well)
Closed Loop System
A.
If Open Loop where is water discharged?
8.
The following questions are for
Closed Loop systems only
A.
Closed loop system designed by
B.
Type of antifreeze used
% Solution
C.
System type:
Series
Parallel
D.
Pipe material
Nominal Size
E.
Pipe Installed:
1. Horizontal
Total length of pipe
ft
No. pipes in trench
Depth bottom pipe
ft
2. Vertical
Total length of bore hole
ft
