>Wait do you install these indoors?

Absolutely. Not just because of the heat, but because large parts of Tennessee are subtropical rainforest (~60+" annual rainfall) so dehumidification is absolutely essential. Why not get free dehumidification from heating water?

Installing an air-exchanging heatpump OUTSIDE?!? is absolutely a massive waste of energy in such a climate (and many more).

>isn't noise an issue?

All four of mine are installed in 20sqft utility closets, using insulated ducting to top-wall registers (also, insulated). For my first install, only, I used a solid metal 90° to pierce the wall/inlet (this one is loudest, basically as if the wall weren't there).

Granted, there is definitely a "louder" side (the inlet-sides), but not by much. None of my utility closets are insulated (from surrounding draw rooms), and the entire unit isn't loud enough to justify more than just a layer of sheetrock on both side of the wall/partition.

If this was installed in a garage, it would definitely be known-to-be-on, but not aggressively-so (if you have a workbench outside, e.g.). I don't know the decibel rating, but it's about the same loudness as a stand-alone dehumidifier (same wattage/concept, actually), without walls.

Should you desire the quietest install, insulate the wall (between studs) and use dual 6" insulated ducting, with switchbacks, for both inlet and outlet (that's a lot of hardware). In such an unnecessary installation, it would be whisper-quiet.