If you have any questions, please contact Randy Ruszkowski at (330) 493-9904, extension 2028, or via email at
ruszkowskir@starkhealth.org
Water Well Test Request Form
Step 1: Save this PDF fillable form on your device.
Step 2: Please complete the following information:
Name: Address:
City: Township/Municipality:
Phone: Email:
Step 3: Please select the type of test(s) you are requesting below.
If a lending institution is requiring a water test, verify what test(s) are being required. Please note that
each lending institution and loan is different.
Check ALL
that Apply
TEST Fee
Days for
Results After
BACTERIA ONLY
(Total Coliform and E Coli)
$72.00 2-3
PROPERTY TRANSFER WELL EVALUATION
(Total Coliform/E Coli, flow yield, well inspection,
and final water well evaluation by the Stark County
$100.00 5-8
RE-SAMPLE PROPERTY TRANSFER WELL
EVALUATION
$72.00 5-8
LEAD - STANDARD $13.00 14-21
LEAD - RUSH* $26.00 7-14
NITRATES/NITRITES - STANDARD $32.00 14-21
NITRATES/NITRITES - RUSH* $64.00 7-14
*Rush results are only available for lead and nitrate/nitrite tests.
Step 4: Submit completed form to online@starkhealth.org.
Our clerical staff will email you the invoice and a link to make payment online. Once payment is made
our field staff will contact you to schedule an inspection time.
