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Manual 2100-537G
Page 49 of 52
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
Manual 2100-537
I
Page 51 of 54
GROUND SOURCE HEAT PUMP
PERFORMANCE REPORT
Thisperformancecheckreportshouldbelledoutbyinstallerandretainedwithunit.