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Do I need a permit for well or septic work in North Carolina?

Short answer: for anything beyond routine service, yes. In North Carolina, as in every state, this work is regulated because it touches the groundwater your neighbors drink.

Work that needs a permit or approval

Installing or replacing a septic system: always permitted, and the design must match a soil evaluation of your site.
Septic repairs that alter the system: replacing a tank or drainfield needs approval; fixing a broken lid or baffle usually doesn't.
Drilling a new well: permitted and logged, so the state knows what is going into the aquifer.
Deepening or hydrofracturing an existing well: typically treated like new construction.
Decommissioning: sealing an abandoned well or septic tank is regulated too; an open one is a direct contamination path.

Work that usually doesn't

Routine septic tank pumping and cleaning
Like-for-like well pump or pressure tank replacement (some jurisdictions still want a notice; ask)
Water testing and inspections

How it works in North Carolina

Septic permits in North Carolina go through your county health department under the state On-Site Wastewater rules: you apply for an Improvement Permit (the site evaluation saying the lot can support a system) and a Construction Authorization before work starts, and the county inspects the installation before it is covered. New wells are also permitted by the county health department, and the state DEQ sets well construction standards and certifies well contractors.

Official North Carolina resources

Who pulls the permit?

Usually your contractor. Licensed installers and drillers handle permitting as part of the job, and in many jurisdictions only a licensed contractor can pull the permit at all. Confirm the quote includes permits and the final inspection. 4,678 licensed pros are listed for North Carolina; browse by city or request free quotes and ask each one how they handle permitting.