Well AbandonmentHARNETT COUNTY DEPARMENT OF PUBLIC HEALTH
Well Abandonment Permit
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Permit Number: Application Number: Applicant Name: n c,n le -A Po P e
Address: 6U Pvroe 5�a�;on (Ld• �iw.n, ac_ Z8s3q
Type of Well: V otal Dept: 7qq Diameter: Z41n Grouted: QA1k Static Water Level: 66.5 g.E
Directions to Site: UID 544w*% -e, (Ld ,P��mp/P�Sb�a
Agent of the St e J _ atD e:-Cs3/c,1I4—
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 tile 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.
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Property Owner's (k Owners' Legal Representative Signature Required