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Flow Controller 3
R e v. : F e b u r a r y 9 , 2 0 1 6
Site Survey Form
Client Name: ____________________________________ Date:
____________________________________
Address: ________________________________________ Surveyed by: _____________________________
Phone: __________________________________________
�
New construction
�
Retrofit
GeoDesigner performed by: _______________________ Phone: ________________ Date: ____________
Soil conditions: ______________________________________________________________________________
Special conditions and requirements: ___________________________________________________________
_____________________________________________________________________________________________
Permit number: _______________ Owner’s preference on location of loop: _________________________
_____________________________________________________________________________________________
Locate property lines, existing structures, future construction, utilities,
and services. Also locate the geo unit, earth loop, penetration etc.
Scale 1 small square = ___________ ft.
Power Lines
❑
overhead
❑
underground
Telephone Lines
❑
overhead
❑
underground
TV Cable
❑
overhead
❑
underground
❑
Water Well
Depth _______ ft.
❑
City Water
❑
Natural Gas
❑
Propane
❑
City Sewer
❑
Private Sewer
❑
Easements
❑
Fuel Lines
❑
Lawn Sprinkler
❑
Drain Tile
❑
Bldg. Penetration
❑
Unit location
❑
Existing condensing unit
❑
Pond
Size ____________
Avg. Depth _______
Min. Depth _______
❑
Other _____________
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