FORM 1
GROUND HEAT EXCHANGER (GHX) INSPECTION AND TEST REPORT
NOTE:
Use separate form for each GHX loop system.
Building:_________________________ Inspection Date:_______________________
Ground Heat Exchanger No. or Description:_________________________________
List the WSHP Unit No.'s served by this GHX: _____________________________
Ground Heat Exchanger Design Water Flow - _____ liters/sec gpm
Calculated purging flow and press to achieve 0.61 m 2 feet/sec
Purging: Flow _____ liters/sec gpm Head _____ kPa psi, Duration of test
_____ min.
Hydrostatic test pressure _____ kPa psi; Duration _____ min.
Did the system pass the pressure test? ___________________________________
Is antifreeze required in system?____ If yes, was antifreeze measured?____
Has a dimensioned drawing been prepared, completely and accurately showing
the layout of the ground heat exchanger? _________________________________
Does the layout differ substantially from the contract documents? ________
If so is the deviation approved? _______________
Depth of installed vertical loops is _____m feet.
(Design is ____
m feet.)
Depth of horizontal piping is _____ m feet.
(Design is _____m feet.)
Are the trenches clear of sharp bends, rocks, or other sharp objects that
could restrict flow?___________________
Are all joints heat fused (butt-, socket-, or saddle-fusion)?_____________
Do the joints have the proper amount of roll-out?_________________________
Has the piping material been cut-out and properly removed from
saddle-fusion tees?_______________
Was the system backfilled properly with good clean backfill material?_____
Comments:_________________________________________________________________
Inspected and approved this _________ date by ____________________________
Title: ___________________________________________________________________
SECTION 15741N
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