Filling out this form and sending it to us will enable us to more accurately estimate the size of the ground source heat pump that is needed for your project. We will also be able to use this data to determine the number of boreholes that you need.

Please print off the form, complete it and send it to us, or scan the completed form and send it to us by email.

You may also cut/copy and paste the form into the message box on our contact us page. There you can fill it in and send it to us.

Customer Details

Customer Name............................................

Address...................................................................

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Postcode..........................

Telephone Daytime....................... Evening...................... Mobile.........................

Email address................................

Company name if applicable: .................................

Site address if different............................................

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Site address postcode or grid ref......................

Planning status eg outline / full granted, applied for, or, not needed

Project summary

Type of building, eg house, offices, village hall...............................

If house, detached, semidetached, number of floors?..........................

Type of construction, ie. timber frame, brick, stone etc.................................

Building design to current "Part L" Building Regulations?.........................

Age of building..................

Type of project eg. new build, extension, refurbishment, conversion

Project start date...................

Electrical supply
Is your supply    Single phase 230-240v, or 3-phase 400v, or both........................

Building regulations
Does your project require Building Regulations approval?..................................

Site plans and heat loss calculations
Do you have plans for the building/site?. If yes please enclose a copy, also any drawings/photos you may have of the property

Do you have heat loss or SAP calculations?, yes or no

If yes please enclose a copy and indicate maximum heat loss here...............kW

Size of property
Internal floor area to be heated please give unit of measure i.e. sq ft or sq metres

Ground floor ........................  Ceiling height........................

First floor ............................Ceiling height.........................

Other.......................Ceiling height............................

Total........................

Number of bathrooms?...................

Number of open fireplaces?.....................

Are you going to have underfloor heating?...............

If yes, how much of the total area?..................

External ground space available for boreholes  Length...........m or ft *  Width...........m or ft

Does the ground space have easy access for our drilling equipment, level, 1.8-2m width access?

Should you have a geological survey for the site, please send it to us

Describe the geology or topography of the site if known

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Insulation
Please describe type, specification and thickness of insulation

Walls........................... Floor.........................Roof........................... Single or double glazing

Use of heat pump

Internal Design Temperature:

18 Deg C to 22 Deg C   or    21 Deg C to 22 Deg C

Type of heating distribution system, eg radiators, underfloor, ducted air

Do you want the heat pump to provide hot water as well as heating?.........................

Do you want the heat pump to provide cooling in summer? ............................

Usual number of occupants of the property............

Any other supplementary heating planned, eg wood burning stove or AGA?  yes/no

Any other renewable energy being considered eg solar thermal, wind turbine?  yes/no

Please return the completed questionnaire to us by post, or email

Synergy Boreholes and Systems Ltd.

Moses Winter Way

Wallingford

OXON

OX10 9FE

info@synergyboreholes.co.uk

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