NCC204595_Annual Fee Invoice_20221001

North Carolina Department of Environmental Quality
Division of Energy, Mineral, and Land Resources
Stormwater Program
r
NPDES Construction Stormwater Permit
wEnm« �•'� 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: NCC204595-2022
lCertificate of Coverage No.: NCC204595
Effective Date: 10/13/2020
Project Name: 2020 Ruiz Lane
Legally Responsible Person:
Kirkwood Cabiness
kwood Dornell Cabiness
1811 Golden Gate Drive
ireensboro, NC
7405-5645
Invoice Date: 10/1/2022
Due Date: 11/1/2022
nual Fee Period: Oct 2022 to Oct 2023
nual Fee: $100
E-mail: kirkwoodcabiness@gmaiLcom
Telephone: [phone]
Site Contact: Kirkwood Cabiness
ite Contact E-mail:
kwoodcabiness@gmaiLcom
actronic payment option is preferred. Type https://deg.nc.gov/SW-epaVments into your browser. If
u select eCheck, there is no convenience fee. The convenience fee for a credit card is 2.65% and the
nvenience 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.
A $25.00 processing fee will be charged for returned check in accordance with North Carolina General
Statute 25-3-512. Contact Danny Smith at [e-mail] or [phone], or Tev
Holloman 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:
httDS://edocs.dea. nc.Eov/Forms/NCG01-Termination