NCC205064_Contact Update Record_20221103

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 11/3/2022 10:28:43 AM (Contact Changes Submitted)

Certificate of NCC205064
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-5064
Original NOI No.* 35053
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Gerringer Mill Road, LLC
Project Name Kernodle Landing Phase 2
Address Terry Smith Trail, Ossipee, NC
County Alamance
Latitude 36.1522
Longitude-79.4796
Date COC Issued* 11/06/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
• BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Kevin Sasser
Individual (Previous)
First Name (New)* Kevin
Last Name (New) * Sasser

NEW Legally
Reflects any revisions above
Responsible
Kevin Sasser
Individual*
Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email*
Permittee Telephone
[phone]
No. (Previous)
NEW Permittee
[phone]
Telephone No.*
Permittee Mailing
P.O. Box 10, 0, Whitsett, NC 27377-9119
Address (Previous)
NEW Permittee
Street Address
Mailing Address*
4425 Sasser Farms Drive
Address Line 2
City
State / Province / Region
Gibsonville
NC
Postal / Zip Code
Country
27249
us
Permittee Street
7237 Pace Drive, 0, Whitsett, NC 27377-9119
Address (Previous)
NEW Permittee Street
Street Address
Address*
4425 Sasser Farms Drive
Address Line 2
City
State / Province / Region
Gibsonville
NC
Postal / Zip Code
Country
27249
US
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact
Kevin Sasser
(Previous)
Site Contact Title
Managing Member
(Previous)
Organization
Gerringer Mill Road, LLC
(Previous)
First Name (New)*
Kevin
Last Name (New) *
Sasser
NEW Site Contact*
Reflects any revisions above
Kevin Sasser

NEW Site Contact
Title
NEW Organization Gerringer Mill Road, LLC
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact [phone]
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing P.O. Box 10, 0, Whisett, NC 27377
Address (Previous)
NEW Site Contact Street Address
Mailing Address* 4425 Sasser Farms Drive
Address Line 2
City
State / Province / Region
Gibsonville
NC
Postal / Zip Code
Country
27249
us
Change Requested Received via email from [e-mail] on Mr. Sasser's behalf.
by: * Address, email, and phone updated (legally responsible person remains the same).
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 11 /03/2022