Total Heat Output Btuhr Btuhr from Electric COP

PLUS

STANDING COLUMN ONLY INFORMATION

PLUS

VERTICAL CLOSED LOOP ONLY INFORMATION

PLUS

OPEN ONE WELL

If RETURN (DIFFUSION) WELL IS USED

PLUS

DIFFUSION WELL (TWO WELL SYSTEM)

STATIC LEVEL IS TO

BLEED SYSTEM INSTALLED & OPERATING?

(AQUASTAT, AUTO-VALVE, ISOLATION & POWER -)

BLEED FLOW RATE is SET to GPM

GROUTED?

RECYCLED WATER PIPE_______IN. & IS TO: (DESCRIBE)

SCREEN SIZE:

FT SLOT SIZE

MAT'L

DIFFUSION WELL PIPE IS____IN & IS

WELL SCREENED

LENGTH_

FT SLOT SIZE

SCREEN SIZE: MAT'L

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