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Submersible Motor Booster Installation Record
Date ______ /______/_______ Filled In By _______________________________ RMA No. _______________
Installation:
Owner/User ________________________________________________ Telephone (______) ____________________
Address ____________________________________________City _______________ State ______ Zip __________
Installation Site, If Different _________________________________________________________________________
Contact ___________________________________________________ Telephone (______) ____________________
System Application________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
System Manufactured By_____________________________Model ________________ Serial No. _______________
System Supplied By_________________________________ City _________________ State ______ Zip _________
Is this a “HERO” system (10.0 - 10.5 PH)? ❑ Yes ❑ No
Motor:
Model No. _______________ Serial No. _______________ Date Code ______
Horsepower ______ Voltage ______ ❑ Single-Phase ❑ Three-Phase Diameter ______ in
Slinger Removed? ❑ Yes ❑ No Check Valve Plug Removed? ❑ Yes ❑ No
Motor Fill Solution ❑ Standard ❑ DI Water
Pump:
Manufacturer _______________ Model _______________ Serial No. _______________
Stages ______ Diameter ________ Flow Rate Of ________ gpm At ______TDH
Booster Case Internal Diameter ________ Material _______________
Controls and Protective Devices:
SubMonitor? ❑ Yes ❑ No If Yes, Warranty Registration No._______________________________________
If Yes, Overload Set? ❑ Yes ❑ No ______ Set At _________________________
Underload Sets? ❑ Yes ❑ No ______ Set At _________________________
VFD or Reduced Voltage Starter? ❑ Yes ❑ No If Yes, Type __________________________________________
Mfr. ______________Setting ________% Full Voltage In ________sec
Pump Panel? ❑ Yes ❑ No If Yes, Mfr. ______________________________Size _______________________
Magnetic Starter/Contactor Mfr. ___________________________ Model __________________Size_______________
Heaters Mfr. _____________________ No. ____________ If Adjustable Set At _______________________________
Fuses Mfr. ____________________ Size ___________ Type _____________________________________________
Lightning/Surge Arrestor Mfr. ________________________ Model __________________________________________
Controls Are Grounded to __________________ with No. ________Wire
Inlet Pressure Control ❑ Yes ❑ No If Yes, Mfr.________ Model _______ Setting _____ psi Delay ____ sec
Inlet Flow Control ❑ Yes ❑ No If Yes, Mfr.________ Model _______ Setting _____ gpm Delay ____ sec
Outlet Pressure Control ❑ Yes ❑ No If Yes, Mfr.________ Model _______ Setting _____ psi Delay ____ sec
Outlet Flow Control ❑ Yes ❑ No If Yes, Mfr.________ Model _______ Setting _____ gpm Delay ____ sec
Water Temperature Control ❑ Yes ❑ No If Yes, Mfr.________ Model _________________________ Delay ____ sec
Set At ________ °F Or ______ °C Located _____________________________________
Form No. 3655 8/00
Submersible Motor Booster Installation Record