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Well AbandonmentHARNETT COUNTY DEPARMENT OF PUBLIC HEALTH Well Abandonment Permit Permit Number: Application Number: 10-5-24973 Applicant Name: BIM Builders/ Danny Pollard Address: 6187 N C 27E Coats NC 27521 Type of Well: BoredTotal Dept: 85 Diameter: 24" Grouted: NO Static Water Level: 54 Directions to Site: SR 1563 Bill Aver Q Agent of the St Date: S- ZY- /a Abandonment Procedure: Abandonment Procedure: 1. Remove all plumbing or piping into the well, along with any obstructions inside the well; 2.Remove as much of the well the casing a possible, but no les than to a depth of three feet below land surface; 3. remove all soil or other subsurface material present down to the top of the remaining well casing, and extending to a width of at least 12 inches outside of the well casing on all sides; 4. Using 5 oz. of hypochlorite solution (such as HTH), disinfect the well in accordance with 15A NCAC 2C .0111 of this Subchapter. Do not use a common commercial household liquid bleach, as this is too weak a solution to ensure proper disinfection; 5. Fill the well up to the top of the remaining casing with cement grout, concrete grout, bentonite grout, dry clay, or material excavated during drilling of the well and then compacted in place; 6. Pour a one foot thick concrete grout or cement grout plug that fills the entire excavated area about the top of the casing, including the area extending on all sided of the casing out to a width of at least 12 inches on all sides; 7. Complete the abandonment process by filling the remainder of the well above the concrete or cement plug with additional concrete grout, cement grout, or soil. Note: Contact Harnett County Environmental Health for appointment prior to beginning of well abandonment procedure. Well must be abandoned by a Certified North Carolina well driller/contractor. op Vic u d 5t 1 Bic iMal-19 9 2Y-iv Owner's or Owners Legal tive Signature Required resenta a'401 Date q--2f- /0