NCC213344_Contact Update Record (Leg Resp and Site Contact)_20221130

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 11/30/2022 12:54:33 PM (Contact Changes Submitted)

Certificate of NCC213344
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-3344
Original NOI No.* 54460
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
H&H Constructors of Fayetteville, LLC
Project Name The Preserve at Lake Upchurch, Phase Two, Section One
Address Cedar Ridge Court, Rockfish Township, NC
County Cumberland
Latitude 34.9632
Longitude-79.0089
Date COC Issued * 06/03/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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
[e-mail]
NEW Billing Email
[e-mail]
Billing Telephone No.
910-849-5272
NEW Billing
[phone]
Telephone No.
(Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Brian Walker
Individual (Previous)
First Name (New)* Leslie
Last Name (New) * Groves

NEW Legally Reflects any revisions above
Responsible Leslie Groves
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 2919 Breezewood Avenue, Suite 400, 0,
Address (Previous) Fayetteville, NC 28303-5283
NEW Permittee Street Address
Mailing Address* 3709 Raeford Road
Address Line 2
Suite 200
City
State / Province / Region
Fayetteville
NC
Postal / Zip Code
Country
28304
USA
Permittee Street 2919 Breezewood Avenue, Suite 400, 0,
Address (Previous) Fayetteville, NC 28303-5283
NEW Permittee Street Street Address
Address* 3709 Raeford Road
Address Line 2
Suite 200
City
State / Province / Region
Fayetteville
NC
Postal / Zip Code
Country
28304
USA
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Brian Walker
(Previous)
Site Contact Title Division President
(Previous)
Organization H&H Constructors of Fayetteville, LLC
(Previous)
First Name (New)* Leslie
Last Name (New) * Groves

NEW Site Contact* Reflects any revisions above
Leslie Groves
NEW Site Contact Division President
Title
NEW Organization H&H Constructors of Fayetteville, 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 910-849-5272
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 2919 Breezewood Avenue, Suite 400, 0,
Address (Previous) Fayetteville, NC 28303-5283
NEW Site Contact Street Address
Mailing Address* 3709 Raeford Road
Address Line 2
Suite 200
City
State / Province / Region
Fayetteville
NC
Postal / Zip Code
Country
28304
USA
Change Requested Leslie Groves via Modification request submitted 11/3/2022 and follow-up emails
by. * from Dennis Gilbert and Jennifer Gardner (with signed change form) on 11/28/2022.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 11 /30/2022