NCC200004_Annual Fee Payment Record_20210218

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 1/1/2021 4:55:09 PM (Workflow Start Event)
Submit by Selkane, Aziza 2/18/2021 2:47:25 PM (2021 Annual Fee Payment Verification for NCC200004-2021)
* Atrium Health
• Selkane, Aziza assigned the task to Selkane, Aziza 2/18/2021 2:46 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: February 12, 2021 5:00
PM 1/1/2021 4:55 PM

NORTH CAROLINA
Environmental Quvllty
Certificate of
NCC200004
Coverage (COC)
This is passed fromthe workflow when the invoice is filed.
No.*
NC Reference COC
NCG01-2020-0004
No.*
Permit Status:
Active
Year COC Issued
2020
This field will be hidden.
2020 Fee Status
Check last year's fee status
Project Name*
CHS Pineville Phase III Bed Tower (#401921)
Project Address*
10628 Park Road, Charlotte, NC
Permittee *
Atrium Health
County
Mecklenburg
Invoice No.*
NCC200004-2021
This is passed fromthe workflow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
1/4/2021
This is passed fromthe workflow when the invoice is filed.
Invoice Due Date*
2/4/2021
This is passed fromthe workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Days Overdue 14
Wait at least 15 days until proceeding to NOD.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payment 2/18/2021
Received* Or, if WAN®or NOT FECBV®, this is the date that status is recorded.
Method of Payment* r electronic
r check
f other
Check Number* 10013406

Fee Status* PAID
Legally Responsible Thomas Washington
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify problem e-rrail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct probleme-Trail address or site contact info
Original Billing E- (If available)
mail
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone
No.
Permittee Email for [e-mail]
30-day Reminder This is the errail for the 3t}day rerrinder if needed (passed fromworldlow).
Site Contact Email [e-mail]
for 30-day Reminder This is the errail for the 3aday reminder if needed (passed fromworldlow)
Billing Contact Email This is theerrail for the 3aday reminder if needed (passed fromworldlow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 2/18/2021