Tile Repair Request

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone:

E-Mail Address:

Where is the tile you need repaired located?

State:

County:

Township:

Section:

Nearest intersecting Streets? (Example: State Hwy 56 and 560th Ave.)

Directions from intersection? (Example: go east 800 ft from intersection to 838 560th Ave, repair tile blowout east approx. 1000')

Do you have Existing Tile Maps:

Yes | No

Do you have the area flagged where repair is needed?

Yes | No

- If area to be repaired is not flagged additional locating charges may apply.

Current Condition of Field:

Planted | Tilled | CRP | Pasture

Type of Repair:

Lift Station Pump Alarm
Clipped Line
Water Pumping out of the Ground
Roots in the Tile

          Will trees be removed?  Yes | No
New Outlet Pipe
Install Intake
Culvert Repair
Blow Out
Other:

Please describe the problem you are currently facing:

Size of tile to be repaired: 4" | 5" | 6" | 8" | 10" | 12"

                        Dual Wall: 12" | 15" | 18"

Where is the problem approximately located in the field?(best description possible, Example: Problem area is approx. 400 ft north of old building site, west of the drainage ditch):