NCC231124_Contact Update Record_20240501

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/1/2024 10:10:31 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC231124
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-1124
Original NOI No.* 136763
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Wayne County Development Alliance
Project Name Goldsboro Collection System Improvements-Phase III
Address S US 117 By-Pass HWY,Goldsboro, NC
County Wayne
Latitude 35.3712
Longitude -78.0145
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 919-731-1503
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Mark Pope
Individual(Previous)
First Name(New)* Craig
Last Name(New)* Foucht

NEW Legally Reflects any revisions above
Responsible Craig Foucht
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 134 North John Street,0,Goldsboro, NC
Address(Previous) 27530
NEW Permittee Street Address
Mailing Address* P.O. Box 10397
Address Line 2
City State/Province/Region
Goldsboro NC
Postal/Zip Code Country
27532-10397 us
Permittee Street 134 North John Street,0,Goldsboro, NC
Address(Previous) 27530
NEW Permittee Street Street Address
Address* 218 E.Walnut Street
Address Line 2
City State/Province/Region
Goldsboro NC
Postal/Zip Code Country
27530 us
Change Requested Craig Foucht(President)via Modification request submitted 4/30/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/01/2024