NCC213623_Annual Fee Invoice_20230601

North Carolina Department of Environmental Quality
Division of Energy, Mineral,and Land Resources
'� ~,�� Stormwater Program
NPDES Construction Stormwater Permit
- �������� � INVOICE
��aAE `J �ty
Annual Permit Fee
This Construction Stormwater annua) fee is required by the North Carolina Administrative Code 143-215.D(a).
The fee covers the administrative costs associated with your permit. The fee is required of any person holding a
permit for any time during the annual fee period, regardless of the facility's operating status. Failure to pay the
fee by the due date will subject the permit to revocation. Operating without a valid permit is a violation and is
subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is needed,you must
reapply,with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
Invoice No: NCC213623-2023 Invoice Date: 6/1/2023
Certificate of Coverage No.: NCC213623 Due Date: 7/1f2023
Effective Date: 6/16/2021 Annual Fee Period: Jun 2023 to Jun 2024
Project Name: Wesleyan Pentecostal Church of
Washington
Annual Fee: $100
Legally Responsible Person: E-mail: [e-mail]
Daniel Woods
Telephone: [phone]
Wesleyan Pentecostai Church of Washington Site Contact: Daniel Woods
7656 U.S. 264 East Site Contact E-mail: danieijoeofwv@gmaiLcom
Washington,NC
27889
Electronic payment option is preferred.Type httF}S:JJdeq.r�c.�ouJSW-epa rr7er�ts into your browser. If you
select eCheck,there is no convenience fee.The convenience fee for a credit card is 2.65%and the convenience
fee for debit card is$3.95.
If you must pay with paper check, please make your check payable to "DEMLR Stormwater Program" and
include the Certificate of Covera�e No. in the memo field along with a copv of this invoice.
A$25.00 processing fee will be charged for returned check in accordance with North Carolina General Statute
25-3-512. Contact Tev Holloman at teu.holloman�r�cder�r.�ov or(919} 707-3649 with any questions.
Remit to: NCDEQ—Division of Energy, Mineral, and �and Resources
Stormwater Program
1612 Mail Service Center
Raleigh NC 27699-1612
If this project has been closed out or sold,you must submit a Notice of Termination (NOT) request here:
https:JJedocs.deq.nc.�ovJFormsJl�CG01-Terminatior� (New owners must obtain a new COC)