NCC191870_Contact Update Record (Legally Resp Change)_20230110

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/10/2023 10:49:11 AM (Contact Changes Submitted)

Certificate of NCC191870
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-1870
Original NOI No.* 15863
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
DR Horton, Inc.
Project Name Collybrooke - DR Horton Lots
Address 150 Willowbrooke Way, Stokesdale, NC
County Rockingham
Latitude 36.2745
Longitude-79.9158
Date COC Issued * 09/16/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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 Jessica Meyer
Individual (Previous)
First Name (New)* Tracey
Last Name (New) * Davis

NEW Legally Reflects any revisions above
Responsible Tracey Davis
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 4011 Mendenhall Oaks Parkway, 0, High
Address (Previous) Point, NC 27265
NEW Permittee Street Address
Mailing Address* 7208 Falls of Neuse Road
Address Line 2
Suite 201
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27615
us
Permittee Street 4011 Mendenhall Oaks Parkway, 0, High
Address (Previous) Point, NC 27265
NEW Permittee Street Street Address
Address* 7208 Falls of Neuse Road
Address Line 2
Suite 201
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27615
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jessica Meyer
(Previous)
Site Contact Title NPDES Technical Compliance Administrator
(Previous)
Organization DR Horton, Inc.
(Previous)
First Name (New)* Tracey
Last Name (New) * Davis

NEW Site Contact* Reflects any revisions above
Tracey Davis
NEW Site Contact Division NPDES Administrator
Title
NEW Organization DR Horton, Inc.
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 919-215-6561
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 4011 Mendenhall Oaks Parkway, 0, High
Address (Previous) Point, NC 27265
NEW Site Contact Street Address
Mailing Address* 7208 Falls of Neuse Road
Address Line 2
Suite 201
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27615
us
Change Requested Tracey Davis via Modification request submitted 1/3/2023.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 01 /10/2023