State of New Mexico - Energy, Minerals and Natural Resources Department

State of New Mexico - Energy, Minerals and Natural Resources Department

1220 S. St. Francis Dr., Santa Fe, NM 87505 www.cleanenergynm.org (505) 476-3310

Geothermal Ground-Coupled Heat Pump System Installation Form (FORM 2)

Geothermal Ground-Coupled Heat Pump System Tax Credit - 3.3.32 and 3.4.19 New Mexico Administrative Code (NMAC) / Project No.
For department use only
Form version date: 9/15/2010

* indicates required information

Taxpayer and Geothermal Ground-Coupled Heat Pump System (System) Information

* Taxpayer Name
* System Location
(Address, City and Zip Code or Description)

IGSHPA Accredited Installer System was installed by homeowner who is the above-named taxpayer.

* Contractor Name / * Telephone
* Name of Authorized Representative / * Title
The contractor named above agrees that the system was installed in full compliance with all applicable federal, state, and local government laws, regulations, codes and standards that are in effect at the time of installation. The contractor has read the certification requirements of 3.3.32 or 3.4.19 NMAC. The installed system will work properly with regular maintenance. The contractor provided written operations and maintenance instructions to the above named taxpayer and posted a one-page summary of these instructions in a sheltered accessible location acceptable to the taxpayer and which is near or at the system’s components.
* Date on which the system was placed into continuous operation
* Contractor Signature by Authorized Representative / * Date

Vertical Borehole System Application Information (Complete this section if your system was installed using vertical boreholes for the loop field(s))

* Office of the State Engineer exploratory Permit number(s) and approval date(s) (if required)
* Drilling Method
* Borehole Diameter(s)
* Number of Boreholes Drilled
* General Description of subsurface geology, or attach copies of drilling logs
* Borehole depth(s)
* Depth to groundwater (if applicable)
* Identify whether system is an “open” or “closed” loop system

Horizontal System Application Information (Complete this section if your system was installed using a horizontal application for the loop field)

* Description of the length, width and depth of the trench or trenches (if applicable)
* General Description of subsurface geology
* If horizontal system was installed using method other than trenching, please describe

Building Code Authority

* Agency / * Telephone
* Name of Authorized Representative / * Title
The system was installed in full compliance with all applicable codes.
* Building Code Authority Signature by Authorized Representative / * Date
The following Alternative System Approval is only to be used when written final inspection approval cannot be obtained from the Building Code Authority:

Alternative System Installation Approval

The Building Code Authority was requested by the contractor or homeowner to conduct a final inspection of the system; however, written final approval from the Building Code Authority was not obtained, was not rejected, and 30 days or more have elapsed since the Building Code Authority was requested to conduct a final inspection. The installed system is operating as designed and presented in the application package.
* Signature
by Authorized Representative of Contractor (if contractor-installed)
by Homeowner (if homeowner-installed) / * Date

TAXPAYER AND CONTRACTOR STATEMENT OF UNDERSTANDING

Geothermal Ground-Coupled Heat Pump Tax Credit – 3.3.32 and 3.4.19 New Mexico Administrative Code

Form version date:

A. If a contractor installs the geothermal ground-coupled heat pump system (system), the contractor shall inform the taxpayer about system design, installation, performance, operation and maintenance by providing the following:

(1) prior to system installation, a summary of the specific system type that meets all 3.3.32 NMAC’s requirements and the system’s capacity or size

(2) upon completion of system installation, written operation and maintenance instructions, including how to conduct simple diagnostic observations and tests to determine if the system is working properly;

(3) upon completion of system installation, a written summary of operation and maintenance instructions, posted at an accessible location acceptable to the taxpayer and that is near or at the system’s components; and

(4) upon completion of system installation, written warranties in effect for equipment and contractor’s labor, including their start and end dates and telephone, address and website contact information, as applicable, for honoring or extending warranties.

B. If the system is installed by a contractor, have a written minimum two year warranty provided by the contractor on parts, equipment and labor with the following exception:

(1) the warranty provided by the contractor on each specific piece of equipment shall not exceed the duration and conditions of the warranty provided by the manufacturer of the equipment against defects in materials and workmanship.

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Taxpayer’s Signature Date

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Contractor’s Signature Date

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