Site Number :

: SURABAYA 630156
Access Road Width (meters)
L 5.8 x W 5.8 +
10 years SAR Forecast Lease Date:
Probability of signing the lease agreement ?
1
2
3
4
5
6
Site Condidtion:
4
Type of Site:
33.64 Lease Space:
Site Use:
Owner's name:
Access hours:
Type of Ownership:
District/Community:
Postal Code:
Site Acq. Subcontractor: SAR Complete Date:
City/Town:
Street / Plot number:
House H. Maskuri
JL. Nyamplungan 10 no 46
Building Name:
H. Maskuri
Owner's address:
Fax:
81553474437
SAR Longitude:
24 Hours
Site/Roof height:
630156
Site Acq. Supervisor:
13-Jun-14
SITE ACQUISITION REPORT
Site Acq. Negotiator:
Radio Planner:
Ground Elevation AMSL of Site: Tower/Mast Height :
State/Province:
112,7440
Jawa Timur
Site Name
Surabaya
81553474437
JL. Nyamplungan 10 no 46
-7.2275 SAR Latitude:
Duration of the permit process?
Estimated Rent:
Can the Site be Leased?
Number of permits required? Did you talk to a Permit Agent about the Site?
Does the owner have the lease ?
LEASE INFORMATION
Total sq meters:
PERMIT INFORMATION
Permit Agency Name Permit Name
Can the site be Permitted?
Owner's telephone:
BADAN PENGELOLA MASJID
Contact telephone:
Contact person:
Fax:
outdoor
Network Element (radio equipment)
Location:
Access Road Condition:
Equipment Room Type:
Single Owner
Corporation
Master Agreement Site
Community Association
Goverment
Partnership
Other
GPS MAP
Rooftop Greenfield
Existing Tower Apartement Building House
Chimney Community Commercial Water Tank
New Tower Industrial Building Hospital
Other
Ground near building
Rooftop indoor(on roof level)
Rooftop outdoor
Ground near tower
Rooftop indoor (not on roof level)
NA Very Bad Bad
OK Good Very Good
NA Very Bad Bad OK Good Very Good
Concrete Shelter
Existing Room
Fiberglass Shelter
Metalic Shelter
Other : No Shelter
Yes No Yes No
100% 80% 60% 40%
Revision number: 01Date of issue: 29-Nov-2013 1of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
Operator Name
1
2
3
4
L x W x H
L x W x H
(V/Amp/kW/Phase)
(meters)
on sketch approval required
Access to PTT's fiber network
If there is no access with heavy truck or mobile crane, how will equipment be transported to the roof?
Elevator dimension:
Heavy truck access:
Existing electric supply (V/Amp/kW/Phase)
Earthing/Lightening Protection System
EXISTING INFRASTRUCTURE INFORMATION
Access to any other telecommunications networks
DIRECTIONS TO SITE
photos included
CONSTRUCTION INFORMATION
CO-LOCATION INFORMATION
Are other operators (existing or planned) on the site?
Drilling Allowed?
Staircase dimension:
3 phase Electric company name:
Length of electrical run:
Will existing electric supply be enough to power the site?
Yes No
Yes No
Yes No
Yes No Yes No
Yes No
Yes No
Yes No
Yes No
Yes No Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No Yes No
Yes No
Revision number: 01Date of issue: 29-Nov-2013 2of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
a) Is site location in a conservation area? Yes No
If yes, please mention conservation area below:
Designated forestry preserve Designated cultural heritage site
Designated wetlands preserve Others :
Designated wild life preserve
Description:
b) Is site location in a social awareness area? Yes No
If yes, please mention social awareness area below:
Schools Hospitals
Churches Other socially sensitive location :
Mosques
Description:
c) Is site location in an environmental awareness area? Yes No
If yes, please mention environmetal awareness area below:
Existing landfill Material fabrication plant
Current/former hazardous waste facilities Dense Industrial area
Dry cleaning location Other environmental awareness area :
Description:

ENVIRONMENTAL, SOCIAL AND CULTURAL ASPECTS
Revision number: 01Date of issue: 29-Nov-2013 3of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
1
2
3
4
5
6
7
OBSTACLES: DESCRIBE ALL OBSTRUCTING OBSTACLES WITHIN 300 METERS,
WHICH ARE OF A HEIGHT EQUAL TO OR HIGHER THAN THE SITE
# Description
Azimuth
(degrees)
Distance
(meters)
Height above
rooftop you are
standing on
ATTACHMENTS
Completely free of obstacles.
(If there are noobstacles, then mark here)

180

45

0

90

270

225 135
315

20m 40m 60m 80m 90m 100m
Street Map Ground Level Site Photos
General Roof Photos List of Required Permits
Proposed BTS location photos Antenna Installation and Roof Sketch
Obstacle Map
Panoramic photos
Revision number: 01Date of issue: 29-Nov-2013 4of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
STREET MAP
Revision number: 01Date of issue: 29-Nov-2013 5of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
GROUND LEVEL PHOTOS
Propose Site (Right View)

Propose Site (Left View)

Propose Site (Back View)

6 meters
6 meters
Propose Site (Front View)

Revision number: 01Date of issue: 29-Nov-2013 6of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
ACCES TO SITE
Access to Site

Acces to SITE

Acces to SITE

Acces to SITE

Acces to SITE

Access to Site

Nearest Pole PLN + 10 meter

Nearest Trafo + xx meter

Revision number: 01Date of issue: 29-Nov-2013 7of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
PANORAMIC PHOTOS
View Direction 0

View Direction 45

View Direction 90

View Direction 135

View Direction 180

View Direction 225

Revision number: 01Date of issue: 29-Nov-2013 8of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
PANORAMIC PHOTOS
View Direction 270

View Direction 315

Revision number: 01Date of issue: 29-Nov-2013 9of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
PHOTOS OF ENVIRONMENTAL, SOCIAL AND CULTURAL ASPECTS
Conservation Area Photo 1

Conservation Area Photo 2

Social Awareness Area Photo 1

Social Awareness Area Photo 2

Environmental Awareness Area Photo 1

Environmental Awareness Area Photo 2

Revision number: 01Date of issue: 29-Nov-2013 10of11 Document title: SAR HCPT Document number:F-BTS-017
Site Number :
: SURABAYA 630156
630156
SITE ACQUISITION REPORT
Site Name
Photo GPS

Photo GPS

Surrounding Area

Surrounding Area

Surrounding Area

Surrounding Area

Revision number: 01Date of issue: 29-Nov-2013 11of11 Document title: SAR HCPT Document number:F-BTS-017