117 Juniper Circle Lot 141LA
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION -
`NQTE-Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name_`
t _ .
Date { ,.I _ /`/ .n,
J2.,
Location LA
w
Sul ydivision Name
i . - .-t e- Lot No. i_ Sec. or Block No.
i
Lot Size ' • " '= .f,
House Mobile Home _ Business Speculation
No. Bedrooms y�
No. Baths �� No. in Family
Garbage Disposal
YES ❑ NO
Specifications `for System:
Auto Dish Washer
YES NO
Auto Wash Machine
YES a❑/ NO -❑
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
"Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
—j ..
(J'1
Certificate of Completion - ^— ��` ,;� Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
�...� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*WiTE+rtssued'(n Compliance with G.S.-of North Carolina, Chapter '130:ArtIcle tipc:; p(3
Sewage Treatment and Disposal Rules (10, NCAC ,]OA .134 ,1968)
Permit Number
NameA�.�,.` C� �� `1 �� �'�Dat�, 3.:f:;I `l` 0 5102
r' Location
Subdivision Name {f 1� "'�> �� Lot No. Sec. or Block No y
Lot Size r>>�,5t".',House '-✓ ' Mobile ome'!C:B sari stt��nl
5 H u ,� s,._ S peculation
:�", /.. %«.!{.0 . 4 ''a �' r i". �" � ..: '�' ... f, �•.h• V yl _' : ....+..�..� �;�s.�,�,..... .....ri4�l..tJ {rt' .l.,�c.,.. ..__.......
No. Bedrooms v4 No Bpths o. in Family,
..r.tc.__
Garbage Disposal YES �, N0#t
t +
{ °; (Spcifi Specification
Auto Dish Washer YES [�' . NO `d �'0 Q.c,�n�
Auto Wash Machines»'� YES` M./ NO '
l:�) I�tivy_ :w+ r t `?; r.. G'!wr Ty.t .._• UU"'�' 'k ,� V,
Type Water Supply, ..� �? '�� _ �✓ %�' . `
*Trispemit Void If sewage{system describedi1w below asr�otnstalled within' 36 months from date of issue.
�r '
e: F j It lt�rlt � 1s inokile tBMrl. !Aatc- Ci 1%; --iv and !l::rnbor of 10onis.
(c' C° t1 ?:1!li �!�!..� „{ . f ice! r^.r+rfr-r� i f •�1 _ / t' + r
b) If t::ctx rtes , itrdusL,y ' r Other, S t oa f ersons served
What
7, ., umN: rand i�pe of.wat r=usinc, tixtur,t c. • r �— I
_4
1!'•21Qr}?. �~ r:liC)rYera ri: tClttlrl�i
qr
�Y, •�<: iyr04 lkl,c,lwt' ;iG.riy:ttl�ii: _. t \ .I.tTt-ix--.tr�,..
b) Hai th641. eli.suroy >rjtsWNnYe"'
)
u l �+cy>rtjr tl tit{?(►51<:(l �br(J L!A
:. ['i 1, iitS�t cir ', tfE',:�{Elft:?tc)t� �°:t F 1�+,;t u.c� ''•'
r lid
_.. _
" r+): t#^''M1Y�:.tj.d�'t.i�Sf?t�.:3�i .i�:rit(1:C .%tf tf �r�..�.J �..�, �...Ia � t'� - � ! . �'�.:d_.4�.. !�_rli{��..:r + �".t.` •- -._... .. ....
iri. :,O j't it' 7?.Si tUti,rtt�-snyraddi i{iris ;.,r F Cp !1;;iC:rl;i of tti�t f: 66ty this sewa(v .rxyslani i5 Intendad to uk (vvel�.. � `+
`Improvement§'permit by 7 ^ r)
*Contact a representative of the, Davie'County Health; Department, for •final..inspection of, this -system between 8:30- Y, j
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-6p,4-5985.
I3�3tE , J
Final Installation Diagram: System Installed by�;,�A�
O;FiNL8 is and»ELY ll ;.: O staLE FOR C0t4PLIANC.f_ WITH ALL `ST,,JE. i'•t4D 1_00,4. t.lr ',;,:
A!!; E'.' 5 Ctrl /..;. t: r (it1t'.r'
14
.� S%i.-�` •i i'%i}.•r-1":T /r•�i, .. ..f �, .fit, -r. ,t i, �,.. �rF., �< ,t,f' �+".. .
,2041
i v :f •„•• ".wi'1'w7�nr .•Mvrwl+wWMs+.w.e'
CAAA
ertificate of Completion, y -Date _`A
A Q
",,'The signing of this certificate shall Indicate that the systemdescribed above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO waybe taken as a guarantee that the system will function
satisfactorily, for any given period of time..a . '
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT
Davie County Health Department
Environmental Health Section C V�
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
1. Permit Requested By
2. Addressfy: / 2 -
Home Phone%l f %L y 9 / %J�_
Business Phone 9 I y- 76 S 7/ Zs -
3. Property Owner if Different than Above l? .4. Mc AZd ,4_i A1
Address SW 1, 1-14,yo1,"E p- z.A
4. Permit To: a) Install✓ Alter Repair
b) Privy Conventional,Z Other Type
Ground Absorption
c) Sub-DivisionRECO W 4L,'&A Sec. DY Lot No. /-VI
5. System used to serve what type facility: House ✓Mobile Home Business
Industry Other
b) Number of people Y-kr-F_E
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions -17' A W 5" "
Bed Rooms! rE Bath Rooms76-rEE Den w/Closet OhF-
b) If Business, Industry or Other, State: Number of persons served
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type of water -using fixtures:
commodes -3 urinals garbage disposal
lavatory 1 showers 9 washing machine
dishwasher sinks L
8. a) Type water supply: Public Private Community_
b) Has the water supply system been approved? Yeses No
9. a) Property Dimensions /ZSR. -2.79's - /;-Jf,6-2AyS
b) Land area designated to building site
c) Sewage Disposal Contractor IV 6 /�A %tea - S Tf',-c- 7—,o -,YT( SE /"U i`C F
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve?
What type?
This is to certify that the information is correct to the best of my knowledge.
/ :7G7 ` l
Date Own Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing
Directions to property:
Jr c./v. /'p r' o o M ,1- A5 F74-
/ 0
'74-
/0 3 ��.G/V /1P' y- e_,' /^e- //=
DCHD (6-82)
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section.
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name Date
Address
Lot Size
FAr.Tr1RC AREA 1 AREA 7 AREA R AREA A
1) Topography/ Landscape Position
S
S
S
S
PS
PS
PS
PS
U
U
U
U
?) Soil Texture (12-36 in.) Sandy,
S
S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
PS
PS
U
U
U
U
3) Soil Structure (12-36 in.)
S
S
S
S
Clayey Soils
PS
PS
PS
PS
U
U
U
U
t) Soil Depth (inches)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Soil Drainage: Internal
S
S
S
S
PS
PS
PS
PS
U
U
U
U
External
S
S
S
S
PS
PS
PS
PS
U
U
U
U
I) Restrictive Horizons
Available Space
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
i) Site Classification
U—UNSUITABLE S—SUITABLE
Recommendations/ Comments:
Described by
SITE DIAGRAM
UCHD (6-82)
Title
PS—Provisionally Suitable
Date
.j
EIV
DAVIE COUNTY HEALTH DEPARTMENT 1� •� L986
A • ENVIRONMENTAL HEALTH SECTION �
SITE EVALUATION CONSENT FORM
1. Complete the form below and return to the Davie County Health Department.
2. Carefully follow the procedures as outlined in the enclosed "Information Bulletin."
NOTE: THE ABOVE MUST BE COMPLETED BEFORE A SANITARIAN WILL BE ABLE TO
BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO: Davie County Health Department, Environmental
Health Section, P. O. Box 665, Mocksville, N.C. 27028
Davie County Health Department
Environmental Health Section
Site Evaluation Consent Form
LOCATION OF PROPERTY. DATE RECEIVED
A — dot 1µ1 8e-r�— -d - Qom" ' (office use only)
yes no 1. 1 am the owner of the -above described property.
g . yes no 2. 1 am not the owner of the above described property, however, I certify that I
have consent from �s*wµ��. - Cv••,. e& -G- , owner to obtain a
owner's name
site evaluation by the Davie County Health Department for the purpose of
determining the suitability for a ground absorption sewage treatment and
disposal system.
es no 3. I hereby give consent to the authorized representative of the Davie County
Health Department to enter upon the above described property and conduct all
testing procedures as necessary to determine its suitability for a ground
absorption sewage treatment and disposal,,4ys�tem. _ p — c
It o
dATL PITURE
`�-z a j
4. 1 hereby authorize the Davie County Health _Department to release site
evaluation results from the above described property to the following:
— Owner only
Owners designated representative
Anyone requesting results
— Only those listed below
,o
6
DAT
DCHD (11 /84)
SIGNATURE
s
FACTORS
1+�.'+gf...a1+4iriirl.w'uraG, R'•u.•.y.a.... 7C.:D"3:'_i+:e.0
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
R O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
AREA 1 AREA 2
Date�����
Lot Size
AREA 3 ARFA d
Topography/ Landscape Position
�,.� S
S
CV7�)
PS
U
U
Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
PS
S
PS
5
LUQ
S
Soil Structure (12-36 in.)
Clayey Soils
S
PS
S
PS
S
PS
S
C-:E�
U
Soil Depth (inches)
S
PS
S
®
S
PS
S
Soil Drainage: Internal
S
A5
S
PS
'::2Eg�
S
PS
'�F
External
S
PS
S
PS
U
S
PS
U
Ste
CU''
U
Restrictive Horizons
Available Space
S
U
U
U
Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
Site Classification
�
OS
�U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
ecommendations/Comments: /% l
escribed by Title -�,. Date
ITE DIAGRAM
li3 �
)Cf,(6-821 '
i
r
r
Y �
` DAVIE COUNTY HEALTH DEPARTMENT
• Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION r
Name ?vo Date 1 v
Address Lot Size
s
570
FACTOPR ARFA(1 1 A FA 9
I I
LA0 =L0 —40
AREA 3 AREA 4
1) Topography/ Landscape Position
PS
PS
US C
U
?) Soil Texture (12-36 in.) Sandy,
Loamy, C�„yg�i, (note 2:1 Clay) i 3,� 2Z
P
S
PS
U
PS
i) Soil Structure (12-36 in.)
Clayey Soils
PS
S
c2L)
�PS�
U
U
U
I) Soil Depth (inches)
PS
�
U
�
U
PS
i) Soil Drainage: Internal
PS
S
PS
��
U
PS
U
U
External
e
&P
CLS
PS
U
U
U
U
i) Restrictive Horizons���
'i
^
�3
Available Space
S
U
U
U
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
1) Site Classification
.�
U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
Described by Title V "�"r' Date `d�y
SITE DIAGRAM
9
n
C
t1 � r3
a1
DCHD (6.82)
4M
APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT y" I
Davie County Health Department 1
r - ` Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN IISSSUUED.
Home Phone 77 0
1. Permit Requested ;BZ 1 �' �D/1/S% Leg. Business Phone T� "�OZZ
2. Address - W . S. ca /Q
3. Property Owner if Different than Above Tme Aq L_t,ZC/G
Address �/�
4. Permit To: a) Installer Alter Repair
b) Privy Conventional Other Type`
Ground Absorptio
c) Sub -Division OA- ec. Lot No.
5. System used to serve what type facility- House1-flMobile ome Business
Industry Other
b) Number of people Q
6. a) If house or mobile home, state size of h ome and number of rooms.
House Dimensions 5'X
Bed Rooms 13 Bath Rooms Z Den w/Closet
b) If Business, Industry or Other, State: Number of persons served
y
What type business, etc.
Estimate amount of waste daily (24 hours)
7. Number and type"of water -using fixtures:
commodes ` S urinals garbage disposal
lavatory. showers % washing machine l
�. dishwasher sinks
8. a) Type,water supply: Public Private Community—�
. b)'Has.the watr supply system been approved? Yes ` No
9. a).'Property Dimensions ZS ZSC7
b) Land area'designated to. building site
Sewage Disposal Contractor
Alb
10. Do.you anticipate any additions or expansions of the facility this sewage system is intended to serve?
.What type?
This is toµeertify that the information is correct ,t the best of my knowledge.
y
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
f ; Allow' 5 days for processing.
Directions to property:' _
I
DCHD (6-62)
9/Z- .
N1
AW
it
DAVIE COUNTY HEALTH DEPART.*TENT
SITE EVALUATION CONSENT FORM
INSTRUCTIONS/PREREQUISTES
1. Complete the form below and return it to the Davie Co. Health Department.
2. Along with the form, remit the amount due as shown on enclosed statement.
3. Carefully follow the procedures as outlined in the enclosed "Information
Bulletin".
4. Notify Health Department upon completion of item number 3.
NOTE: ALL THE ABOVE MUST BE DONE BEFORE A SANITARIAN WILL BE ABLE
TO BEGIN THE REQUESTED EVALUATION.
DETACH HERE AND RETURN TO THE(DAVIE COUNTY HEALTH DEPARTDIENT,P.O. BOX 57)
(14OCKSVILLE, N.C. 27028)
DAVIE COUNTY HEALTH DEPARTMENT
SITE EVALUATION CONSENT roma
LOCATION OF PROPERTY:
5c -2m vat eoj
/0.3 k FOAND r OP,-�
DATE RECEIVED
(office use only)
yes no (1.) I am the owner of the above described property.
K
yes no (2.) I am not the owner of the above describ-A property, however, I
certify that I have consent fromIftAee, /g/Z/C/G,owner to
0 owner's name
obtain a site evaluation by the Health Department for the purpose
of determining the suitability for a ground absorption sewage
disposal system.
yes no (3.) I hereby give consent to the authorized representative of the
!! Davie County Health Department to enter upon the above described
l property and conduct all testing procedures necessary to
determine its suitability for a ground absorption sewage
disposal system. �; Z�Ns7.
-S.Lo
DATE SIGNATURE
(4.) I hereby authorize.the Davie County Health Department to release
site evaluation results from the above described property to the
following:
DATE
SIGNATURE
Owner Only
Owner's designated representative
(� Anyone requesting results
Only those listed below
DAVIE COUNTY HEALTH DEPARTMENT��
Environmental Health Section
P. 0. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name DateY 6
Address Lot Size
FAr.T/1RC ARFA I AREA 9 AREA 3 AREA 4
Topography/ Landscape Position
S
<�
(299::)
S
S
S
<55
U
U
U
') Soil Texture (12-36 in.) Sandy,
Loamy, Clayey, (note 2:1 Clay)
S
PS
S
PS�
S
S
U
1) Soil Structure (12-36 in.)
Clayey Soils
S
PS
S
PS
S
PS
(;R�
S
<:::E"j
U
1) Soil Depth (inches)
S
PS
S
®
S
PS
�) Soil Drainage: Internal
S
'?
S
PS
S
PS
S
External
S
PS
S
PS
S
PS
U
U
U
1) Restrictive Horizons
Available Space
S
U
„SE
U
1) Other (Specify)
S
PS
S
PS
S
PS
S
PS
U
U
U
U
1) Site Classification
Q�
-,U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable
Recommendations/Comments:
7
Described by � Title Date
SITE DIAGRAM
DCHD (6-82)
PaWe (o.un#g Pealth Department
nub CEO= pealth '�Oenry
P. O. BOX 665
gochsuille, Yarth (garolintt 27028
OFFICE OF THE DIRECTOR
August 19, 1984
T & R Construction Company
134 Mayfield Road
Winston-Salem, North Carolina 27104
Gentlemen:
This letter concerns a site evaluation done on lot 141
in Bermuda Run in order to determine its suitability for
installing a septic tank system.
The evaluation revealed a heavy 2:1 shrink swell clay
on the front 200' of the lot. Along the back side of the
lot bordering the property line a less clayey, more suitable
soil was found. Based on present boundaries this office must
classify the lot unsuitable. However, if an easement is
granted and the provisionally soil continues along the back
side of the lot, this classification could possibly be changed
to provisionally suitable.
If you have any questions feel free to call.
Sincerely,
Robert B. Hall, R.S.
jh
TELEPHONE
(704) 634.5985
j ��D ATTORt E:,s AT LAW`
DEED D00K!_._PAGE__JG 1001 WEST FOURTH STREE` ` `�
r.
WINSTON-SALEM, NC 27rp1
A-Je0&&PFDDEED BOOY.47�ePAGE
STATE OF NORTH CAROLINA )
DEED OF EASEMENT
COUNTY OF DAVIE )
�n THIS DEED OF EASEMENT, Made this 304.. day of
IIInrd-i , 1987, by BERMUDA RUN COUNTRY CLUB, INC., a North
Carolina corporation, Grantor, to PINE HALL BRICK AND PIPE
COMPANY, Grantee;
W I T N E S S E T H:
That for and in consideration of One Dollar ($1.00),
the receipt of which is hereby acknowledged, Grantor does hereby
grant to Grantee, and its heirs and assigns, a permanent
easement in and on the property of Grantor in the area described
as follows:
BEGINNING at the southeast corner of Lot 141
as shown on the map of Bermuda Run Golf and
Country Club, Section 9, as recorded in Plat
Book 4, at Page 87, in the Office of the
Register of Deeds of Davie County, North
Carolina, and running thence South 71 degrees
39 minutes 42 seconds East 55 feet -Co a
point; thence North 15 degree's 30 minutes 20
seconds East 125 feet to a point; thence
North 71 degrees 57 minutes 06 seconds West
55 feet .to a point, the northeast corner of
said Lot 141; thence with the eastern line of
said Lot 141 South 15 degrees 30 minutes 20
seconds West 125.00 feet to the point and
place of BEGINNING.
This easement is granted for the purpose of permitting
Grantee to use the area described as a septic drain field and to
install, utilize, repair, replace and maintain a septic tank and
all associated pipes and other facilities and apparatus
reasonably necessary for the purposes of this easement. This
easement shall be and remain a permanent easement in and on the
a•
This instrument is being re-recorded to show
�Pr qr i(,�•�e�'ree Slohl tl it g. rbi_.11630p' the name of the preparer.
'Io7r0�j1� est:F 'Flii'Strest ti'Jisal�n:9cl�m�„iA._C.:1T1.01. �
A
OEF.D BONY.'=LPAGE
DEED DOOK� PAGE ;a/
above-described property for the uses herein stated, and .for
re-entry for necessary maintenance, repair, or replacement of
any materials or equipment installed by Grantee pursuant to this
easement, as the same may become necessary, and said easement is
granted upon the following conditions:
1. Installation. During the process of
installation, care shall be used not to damage the surrounding
property of Grantor more than necessary.
2. Repair of Lawn. Upon completion of installation
of the facilities, and after any subsequent repairs or
maintenance work, the area disturbed shall be returned as near
its original condition as is reasonably possible.
3. Future Repair. After installation, if repairs,
maintenance or replacement of the facilities within the easement
area shall become necessary, such shall be permitted on the
conditions above imposed.
4. In no event shall Grantee or its successors or
assigns utilize any portion of the easement area granted herein
which may lie within five (5) feet of an existing underground
cable running through the easement area or Grantor's adjoining
property.
TO HAVE AND TO HOLD said right and easement unto the
said Grantee and its heirs and assigns forever upon the
above -imposed conditions; and being agreed that the right and
easement hereby granted is appurtenant to and runs with the
adjoining land of the Grantee more particularly described as
Lot 141 as shown on a map of Bermuda Run Golf and Country Club,
Section 9, recorded in Plat Book 4, at Page 87, in the Office of
the Register of Deeds of Davie County, North Carolina.
2
DEEDBpDY.LXrr-gg
.ZD "001"IVPAGE-!�92
IN WITNESS WHEREOF, the said Grantor has hereunto set
its hand and seal the day and year first above written.
[Corporate Seal]
ATTEST:
Secr tary
cou
=&l CORPORATE
_W
SEAL
BERMUDA RUN COUNTRY CLUB, INC.
3
D.—M 1E OOKi .. PACE ew
STATE OF NORTH CAROLINA )
COUNTY OF ()O -U Q )
DEF.Q 000f&PAGE'
This 30""h day of amok , 19n, personally came
before me, , a Notary Public,
�-Ix P WL, being by me duly sworn, says
thatttSThe knows the Common Seal of Bermuda Run Country Club, Inc.
and is acquainted with Qoj),rt.x t 0 �L11. ht90r,i who is the
President of said Corporation, and thatshe, the said
611is the -Apt. Secretary of
said orporation, and saw the said President sign the
foregoing instrument, and saw the said Common Seal of said
Corporation affixed to said instrument by said
President, and that she, the said //�� leer
.LL/`�\�:. .p�� �', , , signed43-a
name in attestation of the execution of said instrument in the
presence of said President of said Corporation.
WITNESS my hand and notarial seal, this �h day of
19.
OFFICIAL SEAL
Notary PubHc,, North Caro*?&.
County of Davie
SANDRA J. MOONEYHAM
My CommissionQXt*es lo-a'7--gi No ary Publi
riTotarial Seal)
My Commission Expires:
my Gorra uSkIm auptrQs ovum- t/, 4.."
NORTH CAROLINA, DAVIE COUNTY
FILED FOR REGISTRATION
4-15-87 2:20 PM
,tG DATE TIME
AND RECORDED IN GOOK 136 PAGE 817
J.K. SMITH, REGISTER OF DEEDS
yDAV�IE COUNTY, N. C.
BY ���� � _;,�.
XTSODW/DEPUTY REGISTER OF DEEDS
The foregoing certificate of Sandra J. Mooneyham, N. P. of Davie County
is certified to be correct. This instrument filed for registration on the
3 day of April, 1987 at 11:00 A. M.' and recorded.in Deed Book 136, page
590.
J. K. SMith, Register of Deeds
By:.... ..