NCC222158_Contact Update Record_20230703

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 7/3/2023 7:58:29 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC222158
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-2158
Original NOI No.* 93824
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Kingsbury Ridge LLC
Project Name Kingsbury Ridge
Address Elliot Bridge Rd,Carvers Creek, NC
County Cumberland
Latitude 35.2122
Longitude -78.8710
Date COC Issued* 06/17/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
4) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 910-723-6516
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible D. Ralph Huff III
Individual(Previous)
First Name(New)* D. Ralph
Last Name(New)* Huff III

NEW Legally Reflects any revisions above
Responsible D. Ralph Huff III
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 100,
Address(Previous) Fayetteville, NC 28303-5283
NEW Permittee Street Address
Mailing Address* 2919 Breezewood Avenue
Address Line 2
Suite 100
City State/Province/Region
Fayetteville NC
Postal/Zip Code Country
28303-5283 us
Permittee Street 2919 Breezewood Avenue,Suite 100,
Address(Previous) Fayetteville, NC 28303-5283
NEW Permittee Street Street Address
Address* 2919 Breezewood Avenue
Address Line 2
Suite 100
City State/Province/Region
Fayetteville NC
Postal/Zip Code Country
28303-5283 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Rebecca Treadaway
(Previous)
Site Contact Title Vice President
(Previous)
Organization
(Previous)
First Name(New)* D. Ralph
Last Name(New)* Huff III

NEW Site Contact* Reflects any revisions above
D. Ralph Huff III
NEW Site Contact Member/Manager
Title
NEW Organization Kingsbury Ridge 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 910-723-6516
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 2919 Breezewood Avenue,Suite 100,
Address(Previous) Fayetteville, NC 28303-5283
NEW Site Contact Street Address
Mailing Address* 2919 Breezewood Avenue
Address Line 2
Suite 100
City State/Province/Region
Fayetteville NC
Postal/Zip Code Country
28303-5283 us
Change Requested Ralph Huff and Kathryn Brown(Land Dev Coordinator)via emails on 6/27/2023 and
by:* 6/29/2023(provided Legally Resp.Change Form), respectively.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 07/03/2023