NCC233412_NOI 169641 Payment Verification_20231116

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 11/14/2023 5:14:54 PM (NCG01 NOI Submission)
Approve by Brooklyn.Broussard 11/15/2023 7:46:42 AM (Review-NOI 169641 Lot 15 Marrin)
IP
• The task was assigned to DEMLR NCG01 NOI Review Team.The due date is: November 17,2023 5:00
PM 11/14/2023 5:15:02 PM
• The task was assigned to Brooklyn.Broussard by round robin distribution 11/14/2023 5:15:02 PM
Submit by Tev.Holloman 11/16/2023 12:42:54 PM (Payment Verification for NCC233412)
41 Tate Rice Homes, Inc
• The task was assigned to DEMLR NCG01 Payment Team.The due date is: December 27,2023 5:00
PM 11/15/2023 7:46:57 AM
• Tev.Holloman assigned the task to Tev.Holloman 11/16/2023 12:42:21 PM

a STA7[
W
Payment Verification
I, i1
�1.
NORTH CAROLINA
Environmental Quality
Project Name Lot 15 Marrin
Is this project funded with ARPA(American Rescue Plan Act)grant funds?
No
Yes
CONFIRMED ARPA Project Number(if applicable)
Lot Numbers (If listed on the eNOI)
Lot 15
NC Reference No.* NCG01-2023-3412
Certificate of NCC233412
Coverage(COC)No.*
Invoice Date 11/15/2023
Initial Invoice No. NCC233412-2023
Initial Fee $ 120.00
Invoice Due Date 12/15/2023
Important: If you change the choice below to Payment NOT RECEIVED,the application will be rejected,and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received* Payment Received.
Payment NOT RECEIVED.
Payment Status PAID
Date Payment 11/16/2023
Received* (Or,if not received,date rejected for no payment)
Method of Payment* electronic
check
Other
ePayment 719537397
Transaction Number*
NOI Tracking No. 169641
Tracking ID referenced upon submittal
This is an Express No
Review Project Yes
Project Tracking ID NCC-FORSY-2023-Lot 15 Marrin

I I