Manual 2100-738C
Page
72 of 73
Ground
Source
Heat
Pump
Performance
Report
Date:
____________________
Technician:
__________________________________________
Company
Reporting:
________________________
Contact
Phone:
____________________________
Owner’s
Name:
____________________________
Owner’s
Address:
___________________________
1. Model/Serial
Numbers:
(For
3
‐
Pc.
Geo
‐
Trio
system,
include
coil/compressor/blower
information)
Model
Number(s):
______________________________________________________________
Serial
Number(s):
_______________________________________________________________
2. Accessory
Information:
Thermostat
Mfgr.
_____________________
Model/Part
Number:
___________________
Flow
‐
Center*
Mfgr.
_____________________
Model/Part
Number:
___________________
*if
applicable
3. Open
‐
Loop
Water
Source
Information:
Where/how
is
water
discharged
___________________________________________________
4.
Closed
‐
Loop
Water
Source
Information:
Horizontal
Trenches
Horizontally
Bored
Vertical
Pond/Lake
Other
(Describe)
________________________________________________________________
Type
of
Antifreeze________________
%
of
Antifreeze
__________
Freezepoint
°F
_________
Piping
Material
____________
Diameter
of
Loop
Pipe
______
Diameter
of
Header
Pipe
_____
Length
of
Loops
________
Pressurized/Non
‐
Pressurized
Flow
Center
_____________________
If
Horz.
Trench:
Loops
per
trench
____
L
x
W
x
D
of
trenches
___________________________
Total
Number
of
Trenches
________
Total
Number
of
Loops
_______
If
Horz.
Bored:
Avg.
Depth
of
Bores
________
Grout
was
used
(Y/N)
___________
Total
Number
of
Bores
___________
Total
Number
of
Loops
___________
If
Vert.
Bored:
Depth
of
Bores
__________
Grout
was
used
(Y/N)
____________
Total
Number
of
Bores
___________
Total
Number
of
Loops
____________
If
Pond/Lake:
Approx.
Acreage
of
Pond/Lake
_______________
Depth
of
Loops
__________
Style
of
Loops:
(coils,
mats,
Lake
Plates)
____________
Total
Number
of
Loops
_____
General
Notes:
________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
