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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
Divisi :
Network Implementation
Rev No:
Page:
Visit Date : Region : Site ID : 02200604 Alt : A
Surveyor : Area : Site Name :
1. GENERAL INFORMATION Type of Site: Roof Top/Greenfield/Existing/Swap/Backbone/BSC
Project Name Contractor
Address (RT/RW, Kelurahan, Kecamatan, Kabupaten, Post Code)
Owner’s Name Ibu Lena
Telephone / Fax Mobile Phone 0852 784 85 123
Contac Person Name
Telephone/Fax Mobile Phone
Type of Ownership Single owner Corporation Other
Government Community Partnership
Surroundings
Perumahan Pekantoran Jalan raya Persawahan
Pabrik Pasar Hotel Mall
Others = Restaurant
Access To site Available Not Available Need Additional
Access 24 hours Yes No, identify hours…………………………………………..
2. CIVIL & ELECTRICAL INFORMATION
Green field
General Topography Soil Classification Site Improvement
Flat Normal Clearing
Swamp Rocky Stripping
Slope Sandy Fill
Hilly Clay / Muld Demolish existing
Roof Top / Pole
Height of Building…………………….Meter Old of building…………………….Years
Building Structure Reinforce Concrete Steell Other…………….
Building Using Home/Office Mall Other…………….
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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Equipment room/Shelter Permanent CKD Other
Existing Room Outdoor Shelter ………………………………….
Dimension = 3 x 1 (m)
Access Road
Use private Access Use Public Access
Length of private access = 35m. X 3m….. Length of public access = ………. X ……….
Access fit for Sedan/minibus/Truck/Big Truck (*) Yes No
Asphalt Hotmix Concrete Paving Block
Aggregate Soil Macadam Other…………..
Level of difficulties in construction Easy Moderate Normal Difficult
If Backfill is required on site, how much the volume (PxLxT) ?
Roof Top Access
Access for Crane Yes No
Stairway available Yes, Dimension ……. X ………. No
Material Lift Yes, Capacity …………… Kg No
Power Source (see pic on add form)
PLN, Distance Pole / Transformer : 60m… m Not Available, need Genset
Provided by Owner including Genset (*) Capacity :………KVA,……..Phase
Additional Required Poles (1) Transformer Cable (how……)
Is there any regular power OFF? Yes No
Duration PLN intentionally shutdown < 3 hours > 3 hours
Cable routingShaft cable Yes No
Proposed routing Tray Clamped Other…………..
3. ACQUISITION AND PERMIT INFORMATION
Land / Rooftop Area Length x Width
(m)15 m x 15 m Area (m2) 225 m2
Acquisition Type Lease 10 Years (min) Can be
extended
Yes
Buy No
LEA
SE
Total Lease Price Payment Method
Leasing Procedures Present of Notaris Without Notaris
Lease Price condition PPh…… Tax Included PPh ……. Tax Not Included
Notaris Fees Included Notaris Fees Not Included
Buy Price / m2
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
Divisi :
Network Implementation
Rev No:
Page:
Visit Date : Region : Site ID : 02200604 Alt : A
Surveyor : Area : Site Name :
BU
Y
Total Price
Buy Price conditions PPAT Fees Included PPAT Fees Not Included
BPHATB 5% Included BPHATB 5% Not Included
Is the price above the reference price ?
Yes No
Transaction terms PLN Power Included PLN Power Not Included
Land Ownership documents
Girik/Persil No.
Sertifikat No.
SPPT/PBB No.
Akte Jual-Beli No.
Lain-lain
Is the site located within 15 km from the airport Yes No
Site not in high criminal area (gambling preman…..etc) Yes No
Site not in forbidden area Yes No
Permits Required For ‘Ijin Mendirikan
RT/RW Tata Kota (RUTR) Military
Kelurahan Bapeda Community
Kecamatan Hub Tel Socialisation
Other :
Permits PossibilitiesGovernment Permits OK Not OK
Community Permits OK Not OK
Civil Recommendation OK NOT OK
Sitac Recommendation OK NOT OK
Other Comment : Prepared By : Cheked By :
4. RF AND TRANSMISSION INFORMATION
Proposed Tower Height : 60 m Plan Antenna Height : m Plan Antenna Type :
Nominal Coordinate Longitude Latitude :
Alternative Coordinate Longitude : Latitude :
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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Visit Date : Region : Site ID : 02200604 Alt : A
Surveyor : Area : Site Name :
Distance from Nominal 22 m
Map Datum and level of GPS WGS 84
RBS Antenna Direction (deg) ..… 0 …… 0 ...… 0
Facing and Geographich Data
Facing Site Direction (deg) Obstacle Remarks of Obstacle Free
Free obstacle surrounding Yes No
Surroundings
Perumahan Pekantoran Jalan raya Persawahan
Pabrik Pasar Hotel Mall
Others = Restaurant
RF Recommendation OK NOT OK
TRF Recommendation OK NOT OK
Other Comment : Prepared By : Checked By :
5. OTHERS COMMENT
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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6. ATTACHMENTS
Street Map (Scanned) Site situation, access, existing facilities Photos
Site Location Sketch & Photos Obstacle objects & near field obstruction Photos & Sketch
Site Layout Sketch Proposed Tower/Poles Location Photos
Rooftop Layout Sketch Proposed Shelter/ER Location Photos
Proposed Cable Trays Photos (co-axil, power, grounding,etc) Proposed Utilities Photos
Panoramic 3600 Photos (Rooftop site) Transmission link sketch
Distance from Nominal Coordinate if its Alternative Site(Mark here with an Alternatives Names “A”, B and “C”)
00
450
1350
1800
2250
2700
3150
Nominal Coordinate
50m
100m
150m 250m
500m900
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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Rev No:
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Visit Date : Region : Site ID : 02200604 Alt : A
Surveyor : Area : Site Name :
Obstacles: describe all obstructing obstacles within 500 meters, which are of a height equal to or higher than the site
Alt Azimuth Distance Height AGL Description
A
B
C
Site Map
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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Visit Date : Region : Site ID : 02200604 Alt : A
Surveyor : Area : Site Name :
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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Visit Date : Region : Site ID : 02200604 Alt : A
Surveyor : Area : Site Name :
Site Layout Sketch (measurement)
Candidate coordinate candidate elevation distance from
NOM
Note: the existing PLN pole and NOM position must be drawn in the street map
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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Site Green Field / Rooftop Layout Sketch
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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PLAN VIEW AND SITE CONTOUR
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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CROSS SECTION IS PRODUCED MIN 10M DISTANCE OUTSIDE OF THE SITE CANDIDATE THAT WILL BE PURCHASED OR RENT. IF ANY DIFFERENCE OF EVALUATION MORE THAN 3M OUT SIDE
OF THE 10M DISTANCE IT MUST BE DESCRIBE ON THE CROSS SECTION SKETCH
ACCESS CONDITION TO THE SITE
main access to site SECONDARY access to site
P x L : ……………………… P x L ………………………….
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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Visit Date : Region : Site ID : 02200604 Alt : A
Surveyor : Area : Site Name :
TERTIARY access to site Planned access to site
P x L : …………………….. P x L : …………………………………………..
Can heavy truck access to location ? Yes No
Access road condition to location ?
Very Good Good Not So Bad Bad Very Bad
CONDITION OF THE SITE
FRONT VIEW RIGHT VIEW
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LEFT VIEW BACK VIEW
surrounding
ELECTRICAL AVAILABILITY
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Please insert the photo of nearest electrical pole here
ELECTRICAL AVAILABILITY
Pole PLN
CONDITION OF THE NOMINAL
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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NOM
PANORAMIC PHOTO DOCUMENTATION
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METROSEL
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TECHNICAL SITE SURVEY ACQUISITION REPORT (TSSAR)
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Network Implementation
Rev No:
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Visit Date : Region : Site ID : 02200604 Alt : A
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0° 45°
90° 135°Remarks on surrounding situation from location :Perumahan dan perkantoran
PANORAMIC PHOTO DOCUMENTATION