NCC204568_Annual Fee Payment Record (2023 Fee)_20231010

Action History (UTC-05:00)Eastern Time(US&Canada)
by Workflow 9/29/2023 10:59:47 AM (Workflow Start Event)
Submit by Tev.Holloman 10/10/2023 3:33:10 PM (2023 Annual Fee Payment Verification for NCC204568-2023)
0 Pinehurst Medical Group, LLC
• The task was assigned to DEMLR NCG01 Annual Fee Team.The due date is: November 10,2023 5:00
PM 9/29/2023 10:59:47 AM
• Tev.Holloman assigned the task to Tev.Holloman 10/10/2023 3:32:05 PM

2023 Annual Fee Payment Verification
NORTH CAROLINA
Environmental Quality
Certificate of NCC204568
Coverage(COC)No.* This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2020-4568
No.*
Permit Status: Active
Year COC Issued 2020
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 PAID
Project Name* Mid Carolina Gastroenterology Expansion
Project Address* 110 Dennis Dr,Sanford, NC
Permittee* Pinehurst Medical Group, LLC
County Lee
Invoice No.* NCC204568-2023
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 10/1/2023
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 11/1/2023
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 10/10/2023
Received* Or,if WAIVED or NOT RECEIVED,this is the date that status is recorded.
Method of Payment* electronic
check
other
Check Number* 4204

Fee Status* PAID
Legally Responsible Brandon Enfinger
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 (If available)
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone No.
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 This is the email for the 30-day reminder if needed(passed from workflow).
for 30-day Reminder
Project Name for 30- Mid Carolina Gastroenterology Expansion
day Reminder The project name is passed from workflow for the 30-day reminder
Permittee Name for Pinehurst Medical Group, LLC
30-day Reminder The permittee is passed from workflow for the 30-day reminder
County for 30-day Lee
Reminder The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 10/10/2023