NCC214346_Annual Fee Payment Record (2023 Fee)_20230717

Action History (UTC-05:00)Eastern Time(US&Canada)
by Workflow 6/29/2023 12:50:54 PM (Workflow Start Event)
Submit by Kieu Tran 7/17/2023 12:57:44 PM (2023 Annual Fee Payment Verification for NCC214346-2023)
0 COC Rescinded
• The task was assigned to DEMLR NCG01 Annual Fee Team.The due date is:August 10,2023 5:00 PM
6/29/2023 12:50:55 PM
• Kieu Tran assigned the task to Kieu Tran 7/17/2023 12:57:32 PM

2023 Annual Fee Payment Verification
NORTH CAROLINA
Environmental Quality
Certificate of NCC214346
Coverage(COC)No.* This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2021-4346
No.*
Permit Status: INACTIVE
Already Rescinded: 7/17/2023
This field appears if the permit has already been terminated.
Year COC Issued 2021
This field will be hidden.
Check previous years for outstanding fees(years that do not apply will be blank):
2020 Fee Status 2021 Fee Status 2022 Fee Status
PAID
WAIVE FEE?* Yes, Payment Not Applicable
No, Payment Still Applies
Project Name* Signature HealthCare of Chapel Hill Facility Expansion
Project Address* 1602 East Franklin Street, Chapel Hill, NC
Permittee* Signature HealthCare, LLC
County Orange
Invoice No.* NCC214346-2023
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 7/1/2023
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 8/1/2023
This is passed from the 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.
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 Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 7/17/2023
Received* Or,if WAIVED or NOT RECEIVED,this is the date that status is recorded.

ePayment
Transaction Number*
Check Number*
Fee Status* WAIVED
Legally Responsible Tony Waldron
Person(Orig.)
Permittee E-mail* [e-mail]
CONFIRM Permittee [e-mail]
E-mail* Opportunity to modify problem e-mail address or permittee contact info
Site Contact E-mail* [e-mail]
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct problem e-mail address or site contact info
Billing E-mail [e-mail]
(if available)
CONFIRM Billing E- [e-mail]
mail Opportunity to correct problem e-mail address or billing contact info
Billing Telephone No. [phone]
Permittee Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed(passed from workflow).
Site Contact Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed(passed from workflow)
Billing Contact Email [e-mail]
for 30-day Reminder This is the email for the 30-day reminder if needed(passed from workflow).
Project Name for 30- Signature Healthcare of Chapel Hill Facility Expansion
day Reminder The project name is passed from workflow for the 30-day reminder
Permittee Name for Signature Healthcare, LLC
30-day Reminder The permittee is passed from workflow for the 30-day reminder
County for 30-day Orange
Reminder The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 7/17/2023