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HASSKON Rev No

:
Divisi :
Page:
TSC -1 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…………….

.. Distance Pole / Transformer : 60m… m Not Available. Tax Not Included Lease Price condition Notaris Fees Included Notaris Fees Not Included Buy Price / m2 . X ………. X ………. Dimension …….HASSKON Rev No: Divisi : Page: TSC -2 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : Equipment room/Shelter Permanent CKD Other Existing Room Outdoor Shelter …………………………………. need Genset Provided by Owner including Genset (*) Capacity :………KVA. Access Road Access fit for Sedan/minibus/Truck/Big Truck (*) Yes No Asphalt Hotmix Concrete Paving Block Aggregate Soil Macadam Other…………. Capacity …………… Kg No PLN. No Material Lift Yes. X 3m….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.……. how much the volume (PxLxT) ? Access for Crane Yes No Roof Top Access Stairway available Yes. 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 …….. Length of public access = ………. Level of difficulties in Easy Moderate Normal Difficult construction If Backfill is required on site. Outside Dimension = 3 x 1 (m) Use private Access Use Public Access Length of private access = 35m..

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 : . Lain-lain Is the site located within 15 km from the airport Yes No Site not in high criminal area (gambling preman…. Akte Jual-Beli No. documents SPPT/PBB No. Land Ownership Sertifikat No.HASSKON Rev No: Divisi : Page: TSC -3 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : Total Price 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.

HASSKON Rev No: Divisi : Page: TSC -4 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM 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 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.… 0 …… 0 ... OTHERS COMMENT .

B and “C”) 00 3150 450 2700 Nominal 50m 150m 250m Coordinate 900 100m 500m 2250 1350 1800 .etc) Proposed Utilities Photos Distance from Nominal Coordinate Panoramic 3600 Photos (Rooftop site) iflinkits Transmission Alternative Site sketch (Mark here with an Alternatives Names “A”. access. grounding. ATTACHMENTS Street Map (Scanned) Site situation. power.HASSKON Rev No: Divisi : Page: TSC -5 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : 6. 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.

HASSKON Rev No: Divisi : Page: TSC -6 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM 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 .

7 0 m B R G .3 " Raya E 1 01 ° 0 1 ' 0 3 .5 " K e K /o tKaek a Pn eb a r u am E 1 0 1 ° 0 1 ' 50 .7 " E lv : 8 2 m d p l Restau rant Ke Pe kanbar u .9" D IS T .HASSKON Rev No: Divisi : Page: TSC -7 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : 12 0° Kantor Pemerintahan DPRD kantor Masuk Jalan Teb in g Cur am Teb in g Cur am Tebin g Cur Teb in am g Cur Teb in am g Cur am Teb in g Cur Tebin am g Cur ST I : Tebin am g Cur N 0 0 ° 1 9 ' 2 4 . 6 0 ° to N O M E lv.10 2 Cafe Teb in g Cur am P r o p o s e d S i te Jalan N 0 0 ° 1 9 ' 4 3 .4 " E 1 0 1 ° 0 1 ' 0 3 .8 0 m d pl Kantor PDAM BPS Kantor N O M IN A L PU N 0 0 ° 1 9 ' 4 3 . 2 2 m B R G .3 " Kantor D IS T . 20 1 ° to C a n d E lv.

HASSKON Rev No: Divisi : Page: TSC -8 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : Site Layout Sketch (measurement) Note: the existing PLN pole and NOM position must be drawn in the street map distance from Candidate coordinate candidate elevation NOM .

2 m A k a n d ib o n g k a r Balai da n d ib e r s ih k a n o le h p e m ilik la h a n s e te la h 3000 Pusa m e n e r i m a p e m b a ya r a n s e w a l a h a n 20 00 t St 1000 0 atistik 1500 15 00 0 Pro pos 50 00 ed Site 50 00 Rum ah Ow ner 1800 .HASSKON Rev No: Divisi : Page: TSC -9 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : Site Green Field / Rooftop Layout Sketch 120° 0 500 35 000 B a n g u n a n S e lu a s 5 m x 8 .

10 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : PLAN VIEW AND SITE CONTOUR .HASSKON Rev No: Divisi : Page: TSC .

HASSKON Rev No: Divisi : Page: TSC .B 0 .0 0 0 15000 S ite CROSS SECTION IS PRODUCED MIN 10M DISTANCE OUTSIDE OF THE SITE CANDIDATE THAT WILL BE PURCHASED OR RENT.11 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : B A B PO TONG AN A . IF ANY DIFFERENCE OF EVALUATION MORE THAN 3M OUT SIDE OF THE 10M DISTANCE IT MUST BE DESCRIBE ON THE CROSS SECTION SKETCH .0 0 0 5000 35000 15000 J a la n Akses S ite POTONG AN B .A 0 .

HASSKON Rev No: Divisi : Page: TSC . P x L : ………………………………………….12 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : ACCESS CONDITION TO THE SITE main access to site SECONDARY access to site P x L : ……………………… P x L …………………………. Can heavy truck access to location ? Yes No Access road condition to location ? ... TERTIARY access to site Planned access to site P x L : …………………….

13 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : Very Good Good Not So Bad Bad Very Bad CONDITION OF THE SITE FRONT VIEW RIGHT VIEW LEFT VIEW BACK VIEW .HASSKON Rev No: Divisi : Page: TSC .

14 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : surrounding ELECTRICAL AVAILABILITY Please insert the photo of nearest electrical pole here ELECTRICAL AVAILABILITY Pole PLN .HASSKON Rev No: Divisi : Page: TSC .

15 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : CONDITION OF THE NOMINAL NOM .HASSKON Rev No: Divisi : Page: TSC .

16 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : PANORAMIC PHOTO DOCUMENTATION 0° 45° .HASSKON Rev No: Divisi : Page: TSC .

HASSKON Rev No: Divisi : Page: TSC .17 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : 90° 135° Remarks on surrounding situation from location : Perumahan dan perkantoran PANORAMIC PHOTO DOCUMENTATION 180° 225° .

18 TECHNICAL SITE SURVEY Network Implementation -METROSEL ACQUISITION REPORT (TSSAR) TELEKOM Visit Date : Region : Site ID : 02200604 Alt : A Surveyor : Area : Site Name : 270° 315° Remarks on surrounding situation from location : Perkantoran .HASSKON Rev No: Divisi : Page: TSC .