NCC230513_Contact Update Record_20240424

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/24/2024 4:38:46 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC230513
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-0513
Original NOI No.* 128113
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
D.R. Horton INC.
Project Name River Road lots
Address River Road, Mayoden, NC
County Rockingham
Latitude 36.4070
Longitude -79.9330
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Prior Rescission Date This field will populate only if COC has already been rescinded.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
4) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 9194972163
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Tracey Davis
Individual(Previous)
First Name(New)* Neil
Last Name(New)* Uldrick

NEW Legally Reflects any revisions above
Responsible Neil Uldrick
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee 9194972163
Telephone No.*
Permittee Mailing 7208 Falls of Neuse Road, Suite 201,
Address(Previous) Raleigh, NC 27615-3244
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
27615-3244 US
Permittee Street 7208 Falls of Neuse Road, Suite 201,
Address(Previous) Raleigh, NC 27615-3244
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
27615-3244 US
Change Requested Neil Uldrick(Division Stormwater Compliance Specialist III)via Modification request
by:* on 4/19/2024.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/24/2024