Manual 2100-577C
Page
49 of 50
Manual
2100-532G
Page
47 of 48
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
#
S/N
THERMOSTAT:
Mfgr
Model
#
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