NCC192033_Annual Fee Invoice_20231001

North Carolina Department of Environmental Quality
Division of Energy, Mineral,and Land Resources
'� ~,�� Stormwater Program
NPDES Construction Stormwater Permit
- �������� � INVOICE
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Annual Permit Fee
This Construction Stormwater annua) 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: NCC192033-2023 Invoice Date: 10/1/2023
Certificate of Coverage No.: NCC192033 Due Date: 11/ll2023
Effective Date: 1 0/2120 1 9 Annual Fee Period: Oct 2023 to Oct 2024
Project Name: Bridge of Life Community
Church
Annual Fee: $100
Legally Responsible Person: E-mail:jfbulll@gmaiLcom
Jerome Bullard
Te I e p h o n e: 910-540-4 902
Bridge of Life Community Chiurch,Inc. Site Contact: Jerome Bullard
P.O. Box 217 Site Contact E-mail: [e-mail]
Delco,NC
28451-4091
Electronic payment option is preferred.Type ht�F}S:JJdeq.r�c.�ouJSW-epa�into your browser. If you
select eCheck,there is no convenience fee.The convenience fee for a credit card is 2.65%and the 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 Covera�e No. in the memo field along with a copv 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 Tev Holloman at teu.holloman�d�q.r�c.�ov or(919) 707-3649 with any questions.
Remit to: NCDEQ—Division of Energy, Mineral, and �and Resources
Stormwater Program
1612 Mail Service Center
Raleigh NC 27699-1612
If this project has been closed out or sold,you must submit a Notice of Termination (NOT) request here:
https:JJedocs.deq.nc.�ovJFormsJl�CG01-Terminatior� (New owners must obtain a new COC)