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

Manual

2100-532B

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Bard QW3S1, QW4S1, QW5S1, QW2S1 installation instructions Ground Source Heat Pump Performance Report