NCC230687_FRO Submitted_20230316

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project Name Foust Elementary School
2. Location of land -disturbing activity: County Guilford City or Township Greensboro
Highway/Street Floyd St. Latitude(decimal degrees) 36.03717 Longitude(decimal degrees)-79.80964
3. Approximate date land -disturbing activity will commence: 08-01-2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Institutonal
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 8.28
6. Amount of fee enclosed: $_900.00 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ❑ No
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name F. Gene Sides, Jr. E-mail Address sidesF((-gcsnc.com
Phone: Office # [phone] Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Guilford County Board of Education
Name Phone: Office # Mobile #
712 N Eugene St.
Current Mailing Address Current Street Address
Greensboro NC 27401
City State Zip City State Zip
10. Deed Book No. 002139 Page No. 00715 Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Barnhill Contracting Company [e-mail]
Company Name E-mail Address
P.O. Box 7948
Current Mailing Address
800 Tiffany Blvd. Ste 200
Current Street Address
Rocky Mount NC 27804 Rocky Mount NC 27804
City State Zip City State Zip
Phone: Office# 252, 823, 1021 Mobile# 252,450,5537
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the iandowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Spruillco, LLC
Name of Registered Agent
P.O. Box 1801
Current Mailing Address
E-mail Address
301 Fayetteville St, Ste. 1900
Current Street Address
Raleigh NC 27601 Raleigh NC 27601
City State Zip City State Zip
Phone: Office #
Mobile #
S�v1n ��I�ti►bbh
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Barnhill/Holt Brothers, a joint venture partnership
Company DBA Name
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
William M. Aycock
Type or print name
Signature
Vice President & CFO
Title or Authority
10/14/2022
Date
a Notary Public of the County of
State of North Carolina, hereby certify that r ► t \-W 1V1. appeared personally
before me this day and being duly sworn acknowledged that the ab ve form was executed by him/her.
Witness my hand and notarial seal, this —'1day of O Ch�e-r , 20 27-
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PMY &f y �.
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Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Name
Current Mailing Address
City State
Deed Book No.
Landowner 3 of Record:
Phone: Office # Mobile #
Current Street Address
Zip City State Zip
Page No. Provide a copy of the most current deed.
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 4 of Record:
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 5 of Record:
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.

Continued from Item 1 in Part 8 of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Holt Brothers, Inc [e-mail]
Company 2 Name E-mail Address
421 Fayetteville St. Ste 1300 421 Fayetteville St. Ste 1300
Current Mailing Address Current Street Address
Raleigh NC 27601 Raleigh NC 27601
City State Zip City State Zip
Phone: Office # 919 . 787 . 1981 Mobile # [phone]
Company 3 Name
E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Company 4 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Company 5 Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #