Site Survey Report

PT. TOWER BERSAMA GROUP SITE SURVEY REPORT

REKAPITULASI LAPORAN SITAC

Site ID SPG049
Site Name Kembang Jeruk Banyuates (Tapaan) DMT
Area Regional 6 - Jatim
Latitude -6.95187°
Center Point Longitude 113.15600°
Search Radius 100 meter
Rencana Type / Tinggi Tower SST-72 Meter
Rencana Type / Ukuran Shelter Shelter Knock Down
ALTERNATIVE P Q R
Latitude -6.951120°
Longtitude 113.156170°
Ground Elevation ( m ) 101 Meter Meter Meter
Jarak dari Center Point 86 Meter Meter Meter
Link to
BSC / Transmission
Alamat Site Dsn. Tapaan, Kec. Banyuates, Kab.
Sampang

Nama / Alamat / No. Tlp Matberi/Dsn. Tapaan, Kec. Banyuates,

Pemilik Lahan Kab. Sampang/'+6285851823264

Nama / Alamat / No. Tlp

Perantara

Ukuran Luas Lahan 20 x 20 meter

( P x L ) m2
Jenis Lahan Pekarangan

Perlu Tidak
Pengurukan / Tidak
Kepadatan Bangunan Kurang Padat
di Sekitar Site
Lebar Jalan Masuk 4 meter

Jenis Permukaan Jalan Jalan Aspal

Masuk
Kondisi Akses Jalan Baik
Masuk
Kondisi Masyarakat Kondusif
Sekitar.
Status Surat Leter C
Kepemilikan Lahan
Cara Perolehan Lahan. Langsung

Harga Beli / Sewa Lahan Sewa 11 tahun Rp. 120 jt

Jarak ke Sumber 60 meter
Listrik PLN
Kondisi Tanah Datar

Rata-rata kedalaman 20 meter

Air Tanah di Sekitar Site
Perizinan Yang Ijin Prinsip, IMB & HO
diperlukan
Apakah Lahan Tidak
merupakan Area Banjir
 Site Survey Report

PT. TOWER BERSAMA GROUP SITE SURVEY REPORT

Site ID SPG049 Site Name embang Jeruk Banyuates (Tapaan) DM

Alternative P Region / Area Regional 6 - Jatim

Survey Date 15-Sep-12

( Tanggal Survey )

Site Address Dsn. Tapaan, Kec. Banyuates, Kab. Sampang

( Alamat Lokasi )

Owners Name / Address / Tlp / Fax Matberi/Dsn. Tapaan, Kec. Banyuates, Kab. Sampang/'+6285851823264
( Nama Pemilik / Alamat / Tlp / Fax )

Contact Person / Address / Tlp / Fax

( Orang yg bisa dihubungi / Alamat / Tlp / Fax )

Latitude -6.951120°
Longtitude 113.156170°
Ground Elevation 101 Meter
Distant From Centre Point 86 Meter
Link To BSC / Transmission

Luas Lahan 20 x 20 meter

Type of Ownership Single Owner / Milik Perorangan

( Status Kepemilikan Lahan ) Corporation / Perusahaan
Government / Pemerintah
Partnership
Community Association
Unclear / Tidak Jelas
Other / Lain - lain

Certificate of Ownership Girik / Persil / Segel

( Sertifikat Kepemilikan ) SPPT
Sertifikat Hak Milik
Sertifikat Hak Guna Bangunan
Akte Jual Beli
Akte Hibah
Other / Lain - lain

Type of Site Tanah Kosong

( Jenis Lahan ) Ada Bangunan
Roof Top

Land Condition Normal

( Kondisi Lahan ) Lunak / Gembur ( Crumble )
Keras / Padat ( Hard )
Berbatu / Karang ( Rocky Soil )
Lain - lain

Nearest Power Line / PLN 60 meter

( Jarak ke Sumber Listrik PLN )
Land Water Level 20 meter
( Kedalaman Air Tanah )
 Site Survey Report

PT. TOWER BERSAMA GROUP SITE SURVEY REPORT

Site ID SPG049 Site Name embang Jeruk Banyuates (Tapaan) DM

Alternative P Region / Area Regional 6 - Jatim

Access Road Condition Hotmix

( Kondisi Jalan Masuk ) Concreate / Beton
Aspal
Tanah Padat
Very Good Good OK Bad

Type of Acquisition Buy / Beli

( Cara Akuisisi ) Rental / Sewa 11 Year / Tahun
Other / Lain-lain

Site Acqisition Price

( Harga Akuisisi )
Site Rental Price
( Harga Sewa Lahan )

Planned Tower Type SST - 42

( Rencana Type Tower ) SST - 62
SST - 72
SST - 72 BB
SST - 82
SST - 92
Other

Planned Shelter Type Shelter Permanent

( Rencana Type Shelter ) Shelter Knock Down
3 x 2 x 3 Roof Top
4 x 2 x 3 Roof Top and Greenfield
4 x 3 x 3 Dual Band Standart
5 x 3 x 3 BSC, BTS
5 x 4 x 3 Back Bone

Permit Requirement Izin Warga

( Perijinan yang diperlukan ) Izin Prinsip
IMB
Izin Lokasi
Izin HO ( Gangguan )
Izin Dephub / Bandara

Additional Information / Comments

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 Site Survey Report

PT. TOWER BERSAMA GROUP SITE SURVEY REPORT

Site ID SPG049 Site Name SPG049

Alternative P Region / Area Regional 6 - Jatim

Akses Jalan Primer 1 Akses Jalan Primer 2

Akses Jalan Primer 3 Akses Jalan Primer 4

Lokasi Tampak Depan ( Timur ) Lokasi Tampak Kiri ( Utara )

Lokasi Tampak Belakang ( Barat ) Lokasi Tampak Kanan ( Selatan )

 Site Survey Report

PT. TOWER BERSAMA GROUP SITE SURVEY REPORT

Site ID SPG049 Site Name Kembang Jeruk Banyuates (Tapaan) DMT

Alternative Q Region / Area Regional 6 - Jatim

O O
Panorama O Panorama 30

Panorama 6OO Panorama 9OO

O O
Panorama 12O Panorama 15O

Panorama 18OO Panorama 21OO

 Site Survey Report

PT. TOWER BERSAMA GROUP SITE SURVEY REPORT

Site ID SPG049 Site Name Kembang Jeruk Banyuates (Tapaan) D

Alternative P,Q,R Region / Area Regional 6 - Jatim

Panorama 24OO Panorama 270

O

Panorama 30OO Panorama 330O

Center Point Pole PLN 20 meter

 Site Survey Report

PT. TOWER BERSAMA GROUP SITE SURVEY REPORT

Site ID SPG049 Site Name Kembang Jeruk Banyuates (Tapaan) D

Alternative P,Q,R Region / Area Regional 6 - Jatim

Kebun Ketela

Kebun Ketela

KAN DIDA T KOORDINAT:

LAT : -6.986460°
LONG : 113.008350°
Distan : 43 m
Elev : 112 meter

Kebun Ketela

N OM
KOORD INAT :
LA T : -6.951870°
LONG : 113.156000°

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