NCC222792_NOI 101153 Payment Verification_20220816

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/3/2022 10:29:13 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/3/2022 10:37:29 AM (Review - NOI 101153 CommWell Health Four Oaks)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/3/2022 10:30 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 8, 2022 5:00 PM
8/3/2022 10:30 AM
by Workflow 8/3/2022 10:37:38 AM (Workflow Start Event)
Submit by Holloman, Tevye L 8/16/2022 8:14:37 AM (Payment Verification for NCC222792)
F Stocks Engineering, P.A.
Holloman, Tevye L assigned the task to Holloman, Tevye L 8/16/2022 8:14 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 14, 2022 5:00
PM 8/3/2022 10:37 AM

Payment •
NORTH CAROLINA
Environmental Quallty
Project Name
CommWell Health Four Oaks
Lot Numbers
(If listed on the eNOl)
NC Reference No.*
NCG01-2022-2792
Certificate of
NCC222792
Coverage (COC) No.*
Invoice Date
8/3/2022
Initial Invoice No.
NCC222792-2022
Initial Fee
$ 100.00
Invoice Due Date
9/2/2022
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
8/16/2022
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
electronic
check
Other
Check Number*
22847
NOI Tracking No.
101153
Tracking ID referenced upon submittal
This is an Express
No
Review Project
Yes
Project Tracking ID
NCC-JOHNS-2022-CommWell Health Four Oaks