Manual 2100-418F
Page
48 of 49
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
