NCC204227_Annual Fee Invoice_20210901

North Carolina Department of Environmental Quality
Division of Energy, Mineral, and Land Resources
F Stormwater Program
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NPDES Construction Stormwater Permit
mlmM a �• '� INVOICE
Annual Permit Fee
This Construction Stormwater annual 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: NCC204227-2021
Certificate of Coverage No.: NCC204227
Effective Date: 9/28/2020
Project Name: Sam's Xpress Car Wash -
nay Varina, NC
Legally Responsible Person:
Sami Nafisi
SXCW Properties II, LLC
7935 Council Place
Suite 100
Matthews, NC
28105-5000
Invoice Date: 9/l/2021
Due Date: 10/1/2021
nual Fee Period: Sep 2021 to Sep 2022
nual Fee: $100
E-mail: [e-mail]
Telephone: [phone]
Site Contact: Chris Morgan
ite Contact E-mail:
[e-mail]
Electronic payment option is preferred. Type https://deg.nc.gov/SW-epaVments into your browser. If
you select eCheck, there is no convenience fee. The convenience fee for a credit card is 2.65% and
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 Coverage No. in the memo field along with a copy of this invoice.
$25.00 processing fee will be charged for returned check in accordance with North Carolina General
atute 25-3-512. Contact Aziza Selkane at [e-mail] or [phone] with questions.
Remit to: NCDEQ— Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh NC 27699-1612
If this project has been closed out, you must submit a Notice of Termination (NOT) request here:
https://edocs.dea.nc.eov/Forms/NCG01-Termination