Contoh Sitac Document

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TSC TECHNICAL SITE SURVEY Network Implementation
-METROSEL ACQUISITION REPORT (TSSAR)
TELEKOM
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

Single owner Corporation Other
Type of Ownership
Government Community Partnership
Perumahan Pekantoran Jalan raya Persawahan
Surroundings 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
General Topography Soil Classification Site Improvement

Flat Normal Clearing
Green field Swamp Rocky Stripping
Slope Sandy Fill
Hilly Clay / Muld Demolish existing
Height of Building…………………….Meter Old of building…………………….Years
Roof Top / Pole Building Structure Reinforce Concrete Steell Other…………….

Building Using Home/Office Mall Other…………….
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Equipment room/Shelter Permanent CKD Other

Existing Room Outdoor Shelter ………………………………….
Dimension = 3 x 1 (m)
Use private Access Use Public Access
Length of private access = 35m. X 3m….. Length of public access = ………. X ……….
Access Road
Access fit for Sedan/minibus/Truck/Big Truck (*) Yes No
Asphalt Hotmix Concrete Paving Block
Aggregate Soil Macadam Other…………..
Level of difficulties in
Easy Moderate Normal Difficult
construction
If Backfill is required on site, how much the volume
(PxLxT) ?
Access for Crane Yes No
Roof Top Access Stairway available Yes, Dimension ……. X ………. No
Material Lift Yes, Capacity …………… Kg No
PLN, Distance Pole / Transformer : 60m… m Not Available, need Genset
Provided by Owner including Genset (*) Capacity :………KVA,……..Phase

Power Source (see pic
Additional Required Poles (1) Transformer Cable (how……)
on add form)
Is there any regular power OFF? Yes No
Duration PLN intentionally shutdown < 3 hours > 3 hours
Shaft cable Yes No

Cable routing Proposed routing Tray Clamped Other…………..
3. ACQUISITION AND PERMIT INFORMATION

Length x Width
Land / Rooftop Area
(m)
15 m x 15 m Area (m2) 225 m2
Lease 10 Years (min) Can be Yes

Acquisition Type
extended
Buy No
Total Lease Price Payment Method
LEASE
Leasing Procedures Present of Notaris Without Notaris
PPh…… Tax Included PPh ……. Tax Not Included

Lease Price condition
Notaris Fees Included Notaris Fees Not Included
Buy Price / m2
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TELEKOM
Total Price
BUY
PPAT Fees Included PPAT Fees Not Included

Buy Price conditions
BPHATB 5% Included BPHATB 5% Not Included
Is the price above the
Yes No
reference price ?
Transaction terms PLN Power Included PLN Power Not Included
Girik/Persil No.
Land Ownership Sertifikat No.

documents 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 RT/RW Tata Kota (RUTR) Military
‘Ijin Mendirikan
Kelurahan Bapeda Community
Kecamatan Hub Tel Socialisation
Other :
Government Permits OK Not OK
Permits Possibilities
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 :
Distance from Nominal 22 m

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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
Perumahan Pekantoran Jalan raya Persawahan
Pabrik Pasar Hotel Mall

Surroundings
Others = Restaurant
RF Recommendation OK NOT OK
TRF Recommendation OK NOT OK

Other Comment : Prepared By : Checked By :
5. OTHERS COMMENT
6. ATTACHMENTS
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TELEKOM
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
3150 450
2700 Nominal 50m 150m 250m

Coordinate 900
100m 500m
2250 1350
1800
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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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r
to
an
n
h
a
ta
K
e
Pmrin
e
STI :
N 00° 19' 24.5"
E 101° 01' 50.9"
DIST. 70 m
BRG. 201° to Cand
Elv.102
Proposed Site
N 00° 19' 43.3"
E 101° 01' 03.3"
DIST. 22 m
BRG. 60° to NOM
Elv.80 mdpl
NOMINAL
N 00° 19' 43.4"
E 101° 01' 03.7"
Elv: 82 mdpl
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Site Layout Sketch (measurement)

distance from
Candidate coordinate candidate elevation
NOM
Note: the existing PLN pole and NOM position must be drawn in the street map
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Site Green Field / Rooftop Layout Sketch
Bangunan Seluas 5m x 8,2m Akan dibongkar

dan dib ersih kan oleh pemilik lahan setelah
menerima pembayaran sewa lahan
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PLAN VIEW AND SITE CONTOUR
B
POTONGAN A - A
0.000
5000 35000 15000

Jalan Akses Site
POTONGAN B - B
0.000
15000
Site
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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 ………………………….
TERTIARY access to site Planned access to site

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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
LEFT VIEW BACK VIEW

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surrounding
ELECTRICAL AVAILABILITY
Please insert the photo of nearest electrical pole here
ELECTRICAL AVAILABILITY
Pole PLN
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CONDITION OF THE NOMINAL
NOM
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PANORAMIC PHOTO DOCUMENTATION
0° 45°
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TELEKOM
90° 135°
Remarks on surrounding situation from location :
Perumahan dan perkantoran
PANORAMIC PHOTO DOCUMENTATION
180° 225°
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TELEKOM
Remarks on surrounding situation from location :

Perkantoran
270° 315°

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HASSKON Rev No:

Project Name Contractor

Owner’s Name Ibu Lena

Telephone / Fax Mobile Phone 0852 784 85 123

Contac Person Name

Telephone/Fax Mobile Phone

Access 24 hours Yes No, identify hours…………………………………………..

2. CIVIL & ELECTRICAL INFORMATION

General Topography Soil Classification Site Improvement

Roof Top / Pole Building Structure Reinforce Concrete Steell Other…………….

Equipment room/Shelter Permanent CKD Other

Roof Top Access Stairway available Yes, Dimension ……. X ………. No

Material Lift Yes, Capacity …………… Kg No

PLN, Distance Pole / Transformer : 60m… m Not Available, need Genset

Provided by Owner including Genset (*) Capacity :………KVA,……..Phase

Duration PLN intentionally shutdown < 3 hours > 3 hours

Shaft cable Yes No

3. ACQUISITION AND PERMIT INFORMATION

Lease 10 Years (min) Can be Yes

Leasing Procedures Present of Notaris Without Notaris

PPh…… Tax Included PPh ……. Tax Not Included

PPAT Fees Included PPAT Fees Not Included

Land Ownership Sertifikat No.

Civil Recommendation OK NOT OK

Sitac Recommendation OK NOT OK

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 :

Distance from Nominal 22 m

Map Datum and level of GPS WGS 84

RBS Antenna Direction (deg) ..… 0 …… 0 ...… 0

Free obstacle surrounding Yes No

Perumahan Pekantoran Jalan raya Persawahan

Pabrik Pasar Hotel Mall

TRF Recommendation OK NOT OK

Street Map (Scanned) Site situation, access, existing facilities Photos

Site Layout Sketch Proposed Tower/Poles Location Photos

Rooftop Layout Sketch Proposed Shelter/ER Location Photos

Panoramic 3600 Photos (Rooftop site) Transmission link sketch

Distance from Nominal Coordinate if its Alternative Site

2700 Nominal 50m 150m 250m

Obstacles: describe all obstructing obstacles within 500 meters,

Alt Azimuth Distance Height AGL Description

Site Layout Sketch (measurement)

Site Green Field / Rooftop Layout Sketch

Bangunan Seluas 5m x 8,2m Akan dibongkar

PLAN VIEW AND SITE CONTOUR

5000 35000 15000

ACCESS CONDITION TO THE SITE

main access to site SECONDARY access to site

TERTIARY access to site Planned access to site

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

LEFT VIEW BACK VIEW

Please insert the photo of nearest electrical pole here

CONDITION OF THE NOMINAL

PANORAMIC PHOTO DOCUMENTATION

PANORAMIC PHOTO DOCUMENTATION

Remarks on surrounding situation from location :