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Manual 2100-532B
Page 45 of 46
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