WQ0034715_NOV-2024-PC-0167_GC 20240325

DoCUSign Envelope ID: 7536992F-CE7D4403-87A2-06078481DED3
Certified Mail # 7020 3160 0000 4109 7019
Return Receipt Requested
Susan Dunnavant, COO
Concert 12 Oaks LLC
300 International Pkwy
Ste 150
Lake Mary, FL 32746
US. Postal Service"
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M 3001NTERNATIO PKWY, STE 350
$ LAKE MARY, FL 32746
March 20, 2
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SUBJECT: NOTICE OF VIOLATION & INTENT TO ASSESS CIVIL PENALTY
Tracking Number: NOV-2024-PC-0167
Permit No. W00034715
The Club at 12 Oaks
Wake County
DearPermittee:
A review of the November 2023 Non -Discharge Analysis Report (NDAR1) for the subject facility revealed the
violations) indicated below:
Reporting Violation(s):
Report Period Due Date
Type of Violation
November 2023 12/31/2023 Late/Missing NDAR-1
A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General
Statute (G.S.) 143-215.1 and the facility's Non -discharge Permit. Pursuant to G.S. 143-215.6A, a civil penalty of
not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or
fails to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-215.1.
If you wish to provide additional it'
discuss overall compliance please
review of your response will be co
Report(s). You will then be notifi
response is received in this Of.
prepared.
■ Complete items 1, 2, and 3.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
SUSAN DUNNAVART, COO
CONCERT 12 OAKS, MC
300 INTERNATIONAL PKWY, STE 35D
LAKE MARY, FL 32746 ''ll
WQ:NOV & INT TO ASSESS CIVIL PENALTY/NOVQ01l1PC-0I6]
WQ0034715/MONCURE COMM HEALTH CENTER/CHATH
702031600pW41097019 M:03/22/2024
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9590 9402 8490 3186 0212 20
7080 3160 0000 4109 7019
X ❑ Agent
❑ Addressee
B. Received by (Printed Name) C. Date of0etNery,
D. Is delivery address different from item 1? 0 Yes
If YES, enter delivery address below: ❑ No
Service Type
Adult Signature
❑ Priority Mail Express®
❑ Registered Mali-
duRSignature Resldcled Delivery
rdfied Mall®
Certified Mall Restrcted Delivery
O egistered MailRestricted
Delivery
gnatum Confirmationla
Collect on Delivery
❑ Signature Confirmation
^-"--' -T Delivery Restricted Delive
Restricted Delivery
fail
ail Restricted Delivery
over 0)
PS Form 3811, July 2020 PSN 753D-02-00D-9053
Domestic Return Receipt

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70203160000041097019
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Latest Update
Your item was delivered to an individual at the address at 11:09 am on March 25, 2024 in LAKE MARY, FL
32746.
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Delivered
Delivered, Left with Individual
LAKE MARY, FL 32746
March 25, 2024, 11:09 am
Arrived at USPS Regional Facility
SEMINOLE-ORLANDO FL DISTRIBUTION CENTER
March 24, 2024, 10:32 am
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