Esr Pasekan Karanganyar (Jaw JB Idm 3490)

CHECK LIST ESR DOCUMENT
Site Name : PASEKAN KARANGANYAR

Site ID : JAW-JB-IDM-3490
Candidate : LAT : 06°17'07.96"S ; LONG : 108°18'50.95"E
Proposed By : PT. XL AXIATA
No DOCUMENT COMPLETENESS
1 Site Information
2 Radio Frequency Data & Information
3 Transmission Data & Information
4 Civil Infrastructure Data & Information
5 Power Availability Information
6 Site situation, access, existing facilities, etc
7 Photo GPS
8 Surroundings tower (radius 200 m)
9 360 degree panorama, each 30 degree
10 Obstacle objects & near field obstruction
11 Existing facing sites
12 Proposed site & Area
13 Actual centerline, North on sketch
14 Location and size of column and beam, existing and additional
15 Proposed Location and Shelter, Tower, AC, Power meter, etc

16 Proposed routing of cables (co-axial, power, grounding, lightening conductor)
17 Antenna type, location, level and direction, present, future
18 Site Outline Drawing
Other Comment by PIC Sitac XL :
PIC Sitac XL Name :

Sign :
Date : 29 November 2018
DOCUMENT
Remark OK NOK
ESR
ESR
ESR
ESR
ESR
Photos & Sketch
Photos
Google MapS & Sketch
Photos
Photos
Photos & Sketch
Photos & Sketch
Sketch
Photos & Sketch
Photos & Sketch

Photos & Sketch
Sketch
Hard Copy
APPROVAL SHEET
ENGINEERING SURVEY REPORT
SITE ID JAW-JB-IDM-3490
SITE NAME PASEKAN KARANGANYAR
CANDIDATE LAT : 06°17'07.96"S ; LONG : 108°18'50.95"E
SITE ADDRESS Jl.Patimura Blok IV RT.018 RW.007 Desa Karanganyar Kec.Pa
PROJECT TYPE Colo
PROPOSE BY PT. XL AXIATA
Note:
SLA Routing Approval per Department is 1 (one) working day
Routing Approval:
Doc ESR In Doc ESR Out

Approval Remark
Date Time Date Time
Sitac
BSS RND
BSS RND
TRM
Civil Eng
Power Eng
Approval 006
Doc ESR Received by Admin NDC
Doc Copy ESR Received by Vendor

SHEET
VEY REPORT
'50.95"E
esa Karanganyar Kec.Pasekan Kab.Indramayu
Remark Sign PIC Name

PReviewed by :
A
R
p
re REQUEST FOR APPROVAL
lp
e
(Tower Rental Project)
r
e
p
o
a
rsvName : Date : 27 Februari 2019
eDate :
d Site ID Site Info Provider Remark
SITE ID : JAW-JB-IDM-3490
tb
SITE NAME : PASEKAN KARANGANYAR
yo
v:
Tower Height : 62.00 M Location Photograph
e
Tower Type : Greenfield
X
n
L
d Project Deff :
o
P Site Search Report
r
T
.Site Address :
b
P Jl.Patimura Blok IV RT.018 RW.007 Desa Karanganyar
Iy
N Kec.Pasekan Kab.Indramayu
C
a
:m
:e
Candidate Proposed Coordinate LOI
DLAT : 06°17'07.96"S ;
:a
D
t
LONG : 108°18'50.95"E Property Document
a
N
(harus sama dgn info koordinat di halaman 1)
e
ta
e
:m
NOM Coordinate
e
LATITUDE : -6.28554
:LONGITUDE : 108.31465
D
P
a
It
C
eDistance NOM to Candidate : 50.04 mtr
:Bearing NOM to Canditate : 270 degree
:
N
A
N
A
NPT . Dayamitra Telekomunikasi
GPIC : Name : Name :
Date : Date : Date :
S
Prepared by : Project :
PT. XL AXIATA Tower Rental New Build / Collocation Existing
Document response / approved : Checked : Doc No : Revision : ………

(by provider)
Site No. : JAW-JB-IDM-3490
Site Name : PASEKAN KARANGANYAR
Visit Date : 21 Februari 2019
I. GENERAL INFORMATION
Area : Jawa Barat
Site Address : Jl.Patimura Blok IV RT.018 RW.007 Desa Karanganyar
Kec.Pasekan Kab.Indramayu
Contact Person :
Phone Number :
PI
Contact Person Address :
C
Si
ta
c Access to site : √ Available Not Available Need a new additional access
X
Remarks : detail information (car entry or by walking or need ladder etc)
L
N Access 24 hours/day :
√ Yes Not identify hours : ………….to……………..
a
m
e:
Si
gn II. GEOGRAPHIC INFORMATION
NOM Coodinates LATITUDE : -6.28554 ; LONGITUDE : 108.31465
GPS Coordinates LAT : 06°17'07.96"S ; LONG : 108°18'50.95"E

: harus sama dengan sampul muka halaman depan
D
at √ Map Datum : WGS 84
e
√ Mark position on map √ A4 sketch from above
:
28
A
III. PHOTOGRAPH DOCUMENTARY
gu Photos taken √
GPS Photo 2 photos
st
√ Surroundings tower (google maps) 1 captures & ske
us
20 √
17 360 degree panorama, each 30 degree 12 photos
√

(by provider) √
√ Proposed site location 4 photos

√ Site Access 8 photos
√ Obstacle objects - photos
At approximately level 62.00 m.a.g.l (meter above ground level)
Taken on √ Ground Exist. Tower Building
Altitude 5 m.a.s.l (meter above sea level)
Mark position on map A4 sketch from above


(by provider)
IV. RADIO FREQUENCY ( RF ) DATA

RBS Antenna Height : 40/40/40 magl
RBS Antenna Direction : √ 65° √ 155° √ 245°
Surroundings :
OBSTACLE Direction (deg) Distance (m) Height (m)
ANTENNA TYPE V-POL X-POL
RBS TYPE INDOOR OUTDOOR MODEL :
Note : Diisi oleh PIC RND XL berdasarkan info & data di SSR
IN GRID /OFF GRID : at °
OTHER COMMENTS BY XL:


(by provider)
Note : Diisi oleh PIC RND XL
RF RECOMMENDATION : OK NOT OK
PIC BSS-RND Name :


(by provider)
V. TRANSMISSION DATA
SITE FACING PLAN
FACING SITES SITE ADDRESS LATITUDE LONGITUDE
TRM CONFIGURATION DATA (*)

ANTENNA
FACING SITES DISTANCE (km) BEARING (degree) DIAMETER (M)
HEIGHT (m)
(*) Diisi hanya untuk Project XL Own Build / oleh Vendor Sitac Regular
SURROUNDINGS (Including Panoramic Photograph)
OBSTACLE DIRECTION (deg) DISTANCE (km) HEIGHT (m)


(by provider)
TRM RECOMMENDATION : OK NOT OK

PIC TRM Name :

(by provider)
VI. CIVIL INFRASTRUCTURES DATA
SITE CATEGORY : Green Field Roof Top √ Existing
GREEN FIELD
General Topographi : √ Flat Swamp Slope
Soil General Classification : √ Normal Rocky Sandy
Obstruction No Trees Building
Site Improvement required : √ Clearing Stripping Cut / Fill
ACCESS TO SITE
Distance from public road : Meter Width : Meter
Type of pavement : Hotmix Asphalt Concrete
Macadam Aggregate Soil
Length of private access : Meter Width : Meter
Type of pavement : Hotmix Asphalt Concrete
Macadam Aggregate Soil
Improvement required : Bridge Pavement Other
PROPOSED AREA TO BE ACQUIRED (GREEN FIELD) (*)

Lot Size : Rent Area :
Access To Site :
ROOF TOP - BUILDING STRUCTURE

Height Structure Type : Stories ………………… number
Roof Top ………………… meter
Penthose ………………… meter
Other ………………… meter


(by provider)
Old of Building : …………… Years
Building Structure Type : Reinforcr Concrete Steel
Building Using : Home Office Mall/Shop
Potential Obstacle When

:
Construction or Operation

(by provider)
ROOF TOP ACCESS

Access for Crane : Yes No
Stairway available : Yes No
- Dimension : ………… m wide X …………… m height
Passenger Lift : Yes No
- Capacity : ………… persons, from ……….. Trough ……………Floor
Material Lift : Yes No
- Capacity : ………… kg, from ……………. Trough ……………Floor
- Dimension : ………… m wide …………… m height
Ladder Yes No
- Dimension m Wide m Depth m Height
Potential Obstacle for Material

:
Equipment delivery
ADDITIONAL SUPPORTING STRUCTURE REQUIRED (*)

Beam : …………………. m length
Access Ladder : …………………. m length ……………. m wide Other : ……………

GROUNDING and LIGHTNING PROTECTION SYSTEM in BUILDING

Is grounding system available ? : No Yes Type and size …………………
Is it possible to use ? : No Yes
Is lightning protect available ? : No Yes Type and size …………………
Is it possible to use ? : No Yes
SHAFT and CABLE ROUTING

Is cable shaft available ? : Yes No
Routing cables/feeder : Tray Clamped Other : …………………
: length : …………………. M (including Routing Drawing)
PROPOSED AREA TO BE ACQUIRED (ROOF TOP) (*)


(by provider)
Lot Size : Rent Area : ..………….. Meter X ……………. Meter = ……….. Meter²
Access To Site : …………… Meter X ……………. Meter = ……….. Meter²

(by provider)
TOWER DATA
Tower Height : 62.00 M From Ground Level From Roop Top Level
Tower Type : Self Supporting Tower Monopole/Single Pole
: Guyed Tower Three Camouflage
LEASING & PERMIT INFORMATION (*)
Lease Space : L 10 Meter X W 10 Meter X H…………… Estimated Ren
Can the site be Leased ? : √ Yes No
Can the site be Permitted ? :

√ Yes No
CIVIL RECOMMENDATION : OK NOT OK

PIC Civil Eng Name :
VII. POWER & ELECTRICITY
POWER SOURCE
Power Availability (PLN) For XL √ Available Not Available Capacity : 13,2 KVA
Distance From Existing PLN Pole : 40 meter nearest Traffo --- m
Provided by building / PLN, Capacity : 150 KVA ( FOR ROOF TOP SITE)
Additional facilities required (*) : Poles √ Cable Transformer Other


(by provider)
POWER RECOMMENDATION : OK NOT OK

PIC Power Eng Name :

(by provider)
VII. ATTACHMENT
DOCUMENT INDICATION
Photo GPS
Surroundings tower (radius 200 m) Google map

360 degree panorama, each 30 degree
Site situation, access, existing facilities, etc
Obstacle objects & near field obstruction
Existing facing sites
Proposed site & Area
Actual centerline, North on sketch
Location and size of column and beam, existing and additional
Proposed Location and Shelter, Tower, AC, Power meter, etc
Proposed routing of cables (co-axial, power, grounding, lightening conductor)
Antenna type, location, level and direction, present, future
Site Outline Drawing

Project :
Tower Rental New Build / Collocation Existing
Revision : ………
PASEKAN KARANGANYAR
V RT.018 RW.007 Desa Karanganyar

b.Indramayu
Need a new additional access
candidate A
photos
captures & sketch
photos
Project :
photos
photos
photos
Tree
Page 1 of 7
Project :
MODEL :
Project :
Page 2 of 7
Project :
ALTITUDE (masl)
HEIGHT (m)
Project :
page 3 of 7
Project :
Hilty
Clay / Muld
……………..
Demolist existing
Meter
Paving Block
……………..
Meter
Paving Block
……………..
Project :
Other
School/hospital
page 4 of 7
Project :
m height
……………Floor
……………Floor
m height
Other : ………………..
Other : …………………
(including Routing Drawing)

Project :
..………….. Meter X ……………. Meter = ……….. Meter²
…………… Meter X ……………. Meter = ……….. Meter²
page 5 of 7
Project :
From Roop Top Level
Estimated Rent ?
building / PLN, Capacity : 150 KVA ( FOR ROOF TOP SITE)
Other
Project :
page 6 of 7
Project :
Photos
Google maps & Sketch
Photos
Photos & Sketch
Photos
Photos & Sketch
Photos & Sketch
Sketch
Photos & Sketch
Photos & Sketch
Photos & Sketch
Sketch
Hard Copy
Project :
page 7 of 7
PHOTOGRAPH DOCUMENTARY
Site No. : JAW-JB-IDM-3490 Project : XL
Site Name : PASEKAN KARANGANYAR Location : Jawa Barat

Prepared by : PT. Dayamitra Telekomunikasi
Surveyor : Tsani
Foto GPS

Surveyor : Tsani
Name Plate
Site No. : JAW-JB-IDM-3490 Project :
Site Name : PASEKAN KARANGANYAR Location :

Prepared by :
Surveyor : Tsani
XL
Jawa Barat
PT. Dayamitra Telekomunikasi


Prepared by :
Surveyor : Tsani
Degree View Panorama View
30
XL
Jawa Barat
Remarks

Prepared by :
Surveyor : Tsani
60
90
XL
Jawa Barat
Remarks

Prepared by :
Surveyor : Tsani
120
150
XL
Jawa Barat
PT.Dayamitra Telekomunikasi
Remarks

Prepared by :
Surveyor : Tsani
180
210
XL
Jawa Barat
Remarks

Prepared by :
Surveyor : Tsani
240
270
XL
Jawa Barat
Remarks

Prepared by :
Surveyor : Tsani
300
330
XL
Jawa Barat
Remarks

Surveyor : Tsani
PANORAMA 90°
PANORAMA 210°
PANORAMA 330°

Surveyor : Tsani
TAMPAK DEPAN
TAMPAK BELAKANG

Surveyor : Tsani
TAMPAK KIRI
TAMPAK KANAN

Surveyor : Tsani
PROPOSED ANT. SECTOR2.5 M

ELV.± 40.00 mAGL
AZIMUTH : 65⁰/155⁰/245⁰
PROPOSED ANT. MW 0.6 M
ELV.40.00 mAGL
AZIMUTH : 335⁰
Proposed Antenna
Proposed RBS

Prepared by :
Surveyor : Tsani
SITE ACCESS TO SITE

XL
Jawa Barat
SITE ACCESS TO SITE


Surveyor : Tsani
PLN/POWER POLE

Surveyor : Tsani
SITE SITUATION 1
SITE SITUATION 2

Esr Pasekan Karanganyar (Jaw JB Idm 3490)

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CHECK LIST ESR DOCUMENT

Site Name : PASEKAN KARANGANYAR

2 Radio Frequency Data & Information

3 Transmission Data & Information

4 Civil Infrastructure Data & Information

5 Power Availability Information

6 Site situation, access, existing facilities, etc

8 Surroundings tower (radius 200 m)

9 360 degree panorama, each 30 degree

10 Obstacle objects & near field obstruction

11 Existing facing sites

12 Proposed site & Area

13 Actual centerline, North on sketch

14 Location and size of column and beam, existing and additional

15 Proposed Location and Shelter, Tower, AC, Power meter, etc

17 Antenna type, location, level and direction, present, future

18 Site Outline Drawing

Other Comment by PIC Sitac XL :

PIC Sitac XL Name :

Photos & Sketch

Google MapS & Sketch

Photos & Sketch

Photos & Sketch

Photos & Sketch

Photos & Sketch

SITE NAME PASEKAN KARANGANYAR

CANDIDATE LAT : 06°17'07.96"S ; LONG : 108°18'50.95"E

SITE ADDRESS Jl.Patimura Blok IV RT.018 RW.007 Desa Karanganyar Kec.Pa

PROJECT TYPE Colo

PROPOSE BY PT. XL AXIATA

Doc ESR In Doc ESR Out

Doc ESR Received by Admin NDC

Doc Copy ESR Received by Vendor

esa Karanganyar Kec.Pasekan Kab.Indramayu

Remark Sign PIC Name

Document response / approved : Checked : Doc No : Revision : ………

Site No. : JAW-JB-IDM-3490

Site Name : PASEKAN KARANGANYAR

Visit Date : 21 Februari 2019

GPS Coordinates LAT : 06°17'07.96"S ; LONG : 108°18'50.95"E

Document response / approved : Checked : Doc No : Revision : ………

√ Proposed site location 4 photos

At approximately level 62.00 m.a.g.l (meter above ground level)

Taken on √ Ground Exist. Tower Building

Altitude 5 m.a.s.l (meter above sea level)

Mark position on map A4 sketch from above

Document response / approved : Checked : Doc No : Revision : ………

IV. RADIO FREQUENCY ( RF ) DATA

RBS Antenna Direction : √ 65° √ 155° √ 245°

OBSTACLE Direction (deg) Distance (m) Height (m)

ANTENNA TYPE V-POL X-POL

RBS TYPE INDOOR OUTDOOR MODEL :

IN GRID /OFF GRID : at °

OTHER COMMENTS BY XL:

Document response / approved : Checked : Doc No : Revision : ………

Note : Diisi oleh PIC RND XL

PIC BSS-RND Name :

Document response / approved : Checked : Doc No : Revision : ………

SITE FACING PLAN

FACING SITES SITE ADDRESS LATITUDE LONGITUDE

TRM CONFIGURATION DATA (*)

SURROUNDINGS (Including Panoramic Photograph)

OBSTACLE DIRECTION (deg) DISTANCE (km) HEIGHT (m)