Telecommunications Application (New or Modifications) - 202307121547536570
Telecommunications Application (New or Modifications) - 202307121547536570
Telecommunications Application (New or Modifications) - 202307121547536570
Planning Department
111 E. Second St., P.O. Box 879
Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
TELECOMMUNICATIONS APPLICATION
TOWER COLLOCATION, MODIFICATION OR UPGRADE
(ELIGIBLE FACILITIES)
Pursuant to Article 7, Section 155.707 of the Unified Development Code, an owner of land within the
jurisdiction of the Town may petition the Planning Director to approve a Minor Site Plan application.
Application Review Fee: $1000.000
SITE INFORMATION:
EXPLANATION OF PROJECT:
July 2023
PROPERTY OWNER INFORMATION:
Name:
Mailing Address:
Phone Number: Fax:
Email Address :
Name:
Mailing Address:
Phone Number: Fax:
Email Address :
APPLICANT INFORMATION:
Applicant:
Mailing Address:
Phone Number: Fax:
Contact Person:
Email:
The following items must accompany a Telecommunications Site Plan application. This information is
required to be present on all plans, except where otherwise noted:
APPLICANT AFFIDAVIT
I/We, the undersigned, do hereby make an application and petition to the Planning Director of the Town of
Clayton to approve the subject Telecommunications Plan. I hereby certify that I have full legal right to
request such action and that the statements or information made in any paper or plans submitted herewith
are true and correct to the best of my knowledge. I understand this application, related material and all
attachments become official records of the Planning Department of the Town of Clayton, North Carolina, and
will not be returned.
July 2023
TOWN OF CLAYTON
Planning Department
111 E. Second St., P.O. Box 879
Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
AGENT/APPLICANT INFORMATION:
I hereby give CONSENT to the above referenced agent/applicant to act on my behalf, to submit applications and all
required materials and documents, and to attend and represent me at all meetings and public hearings pertaining to the
following processes (list applicable requests):
Furthermore, I hereby give consent to the party designated above to agree to all terms and conditions which may arise as
part of the approval of this application.
I hereby certify that I have authority to execute this consent form as/on behalf of the property owner. I understand that
any false, inaccurate or incomplete information provided by me or my agent will result in the denial, revocation or
administrative withdrawal of this application, request, approval or permits. I further agree to all terms and conditions
which may be imposed as part of the approval of this application.
OWNER AUTHORIZATION:
STATE OF
COUNTY OF
Sworn and subscribed before me _, a Notary Public for the above State and County, this
the day of _, 20 .
My Commission Expires:
January 2018
TOWN OF CLAYTON
Planning Department
111 E. Second St., P.O. Box 879
Clayton, NC 27528
Phone: 919-553-5002
Fax: 919-553-1720
Application shall include the following materials to the Town of Clayton (with review by
CTS). An application is not considered complete until all required information is provided.
1 hard copy and 1 digital copy (digital copy can be on USB or emailed) of the
following information in the format specified below, mailed to:
Town of Clayton Planning Department
PO Box 879
Clayton, NC 27528
3) Fee
Project Fee in the amount of $1,000, payable to the Town of Clayton (this fee includes all
application and review fees, including consultant fee).
5) Compliance Letter
A signed Compliance letter acknowledging compliance with the ordinance and all applicable laws,
rules and regulations, i.e. federal, State and local, including but not limited to i) compliance with all
safety-related requirements; and ii) a commitment to promptly remedy any interference caused by
6) Site Plan
Site plan done to scale. Required when any new exterior ground-mounted equipment or enclosures
are proposed or when any changes are made to ground-mounted equipment, structures or
foundations.
8) Structural Report
A Certified Structural Report (for anything other than attachments to most buildings). It will be a
judgment call on certain building-related situations, e.g. primarily related to the placement of
shelters and if there are adequate support members beneath the roof to support the structure. Coax
layout must be provided if not included in Structural Analysis Report
9) Inspection Report
For towers, a Certified TIA ANSI 222 G Inspection Report, stating the methodology used and all
measurements and calculations, for the following:
- Twist and Plumb measurements for any lattice tower, including allowable tolerances for
each of the points measured;
- a Plumb report for any monopole, including allowable tolerances for each of the points
measured;
- A guy tensioning report for lattice towers including allowable tolerances;
- For anchors that are directly buried, i.e. not encased in a concrete anchor, photos of each
anchor at a depth of at least 18” showing the condition of the anchor vis-a-vis rust and
corrosion.
- A signed, dated letter in lieu of photographs is generally sufficient to illustrate ANSI TIA
222 report remediation efforts, unless given the fact and circumstances other proof of
remediation is deemed appropriate. The signed letter must include the date of remediation
work and a description of what was done, e.g. not simply “all items repaired”. Requested
Twist &/or Plumb information must be provided as appropriate, e.g. Plumb only
information for a monopole.
FORMAT
Project Name
Telecommunications Facility
1) Shall, at all times and without exception, be maintained in a safe manner, and in compliance with
all conditions of all permits and authorizations.
2) Shall at all times be operated and maintained in compliance with all federal, State and local laws,
codes, ordinances, rules and regulations, including but not limited to those related to electrical
powering limits and RF emissions.
Signed by: , being authorized to sign for and legally commit the
Applicant
Print Name:
Date:
SITE INFORMATION
CO-LOCATION _ MODIFICATION _
Site
Address:
City: County:
Tax Map Parcel/ PIN Zoning
#: District:
Please provide a DETAILED narrative description of the wireless communications facilities work proposed
and the reason or need for the work, e.g. gap in coverage, capacity, change in technology. Do not assert a gap,
unless there is truly a gap in service. Use a separate sheet if needed.
(Taken from the FCC’s “A Local Government Official’s Guide to Transmitting Antenna RF Emission Safety: Rules,
Procedures, and Practical Guidance”, Appendix A)
Purpose: The FCC has determined that many wireless facilities are unlikely to cause human
exposures in excess of RF exposure guidelines. Operators of those facilities are exempt from
routinely having to determine their compliance. These facilities are termed "categorically
excluded." Section 1.1307(b)(1) of the Commission's rules defines those categorically excluded
facilities. This checklist will assist state and local government agencies in identifying those
wireless facilities that are categorically excluded, and thus are highly unlikely to cause exposure
in excess of the FCC’s guidelines. Provision of the information identified on this checklist may
also assist FCC staff in evaluating any inquiry regarding a facility’s compliance with the RF
exposure guidelines.
BACKGROUND INFORMATION
Signed: Date:
Title:
Continue
FCC/LSGAC Local Official’s Guide to RF
Checklist (page 2)
If box 16 is checked, this facility is categorically excluded and is unlikely to cause exposure in
excess of the FCC’s guidelines. The remainder of the checklist need not be completed. If box
16 is not checked, continue to question 17.
17. Enter the power threshold for categorical exclusion for this service from the attached Table 1
in watts ERP or EIRP∗ (note: EIRP = (1 64) X ERP):
18. Enter the total number of channels if this will be an omnidirectional antenna, or the
maximum number of channels in any sector if this will be a sectored antenna:
19. Enter the ERP or EIRP per channel (using the same units as in question 17):
20. Multiply answer 18 by answer 19:
21. Is the answer to question 20 less than or equal to the value from question 17 (yes or no)?
If the answer to question 21 is YES, this facility is categorically excluded. It is unlikely to cause
exposure in excess of the FCC’s guidelines.
If the answer to question 21 is NO, this facility is not categorically excluded. Further
investigation may be appropriate to verify whether the facility may cause exposure in excess of
the FCC’s guidelines.
"ERP" means "effective radiated power" and "EIRP" means "effective isotropic radiated power
∗
FCC/LSGAC Local Official’s Guide to RF
TABLE 1 (cont.)
General Wireless Communications Service total power of all channels > 1640 W EIRP
(part 26)
Wireless Communications Service total power of all channels > 1640 W EIRP
(part 27)
TABLE 1 (cont.)
TABLE 1 (cont.)
APPENDIX B
Table B1-1. Estimated "worst case" horizontal* distances that should be maintained from a
1 1.6 4.8
5 8.2 10.8
10 16.4 15.2
25 41 24.1
50 82 34.1
For intermediate values not shown on this table, please refer to the Figure B1-1
*These distances are based on exposure at same level as the antenna, for example, on a rooftop or in a building directly across from and at the
same height as the antenna.
Note: These estimates are worst case, assuming an omnidirectional antenna using 96 channels. If the systems are using fewer
channels, the actual horizontal distances that must be maintained will be less. Cellular omnidirectional antennas transmit more
or less equally from the antenna in all horizontal directions and transmit relatively little energy directly toward the ground.
Therefore, these distances are even more conservative for “non-horizontal” distances, for example, distances directly below
an antenna.
FCC/LSGAC Local Official’s Guide to RF
Figure B1-1. Estimated "worst case" horizontal* distances that should be maintained from a
single omni-directional cellular base station antenna to meet FCC RF exposure guidelines
110
(Based on a maximum total of 96 channels per antenna)
100
Effective Radiated Power Per Channel(watts)
90
0.5 watt/channel
80 1 watt/channel
5 watts/channel
70 10 watts/channel
25 watts/channel
60 50 watts/channel
100 watts/channel
50
40
30
20
10
0
0 5 10 15 20 25 30 35 40 45 50
* These distances are based on exposure at same level as antenna, for example, on a rooftop or in a building
directly across from and at the same height as the antenna.
Note: These estimates are worst case, assuming an omnidirectional antenna using 96 channels. If the systems are
using fewer channels, the actual horizontal distances that must be maintained will be less. Cellular omnidirectional
antennas transmit more or less equally from the antenna in all horizontal directions and transmit relatively little
energy directly toward the ground.
FCC/LSGAC Local Official’s Guide to RF
Table B1-2. Estimated "worst case" horizontal* distances that should be maintained from a single,
sectorized, cellular base-station antenna to meet FCC RF exposure guidelines
1 1.6 2.3
5 8.2 5
10 16.4 7.1
25 41 11.3
50 82 16
For intermediate values not shown on this table, please refer to the Figure B1-2
*These distances are based on exposure at same level as the antenna, for example, on a rooftop or in a building directly across
from and at the same height as the antenna.
Note: These estimates are "worst case," assuming a sectorized antenna using 21 channels. If the systems are using fewer
channels, the actual horizontal distances that must be maintained will be less. Cellular sectorized antennas transmit more or
less in one direction from the antenna in a horizontal direction and transmit relatively little energy directly toward the ground.
Therefore, these distances are even more conservative for “non-horizontal” distances, for example, distances directly below
an antenna.
FCC/LSGAC Local Official’s Guide to RF
Figure B1-2. Estimated "worst case" horizontal* distances that should be maintained from a
single sectorized, cellular base station antenna to meet FCC RF exposure guidelines
100
0.5 watt/channel
Effective Radiated Power Per Channel (watts)
90 1 watt/channel
5 watts/channel
80 10 watts/channel
25 watts/channel
70 50 watts/channel
100 watts/channel
60
50
40
30
20
10
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
* These distances are based on exposure at same level as antenna, for example, on a rooftop or in a building directly
across from and at the same height as the antenna.
Note: These estimates are "worst case", assuming a sectorized antenna using 21 channels. If the systems are
using fewer channels, the actual horizontal distances that must be maintained will be less. Cellular sectorized
antennas transmit more or less in one direction from the antenna in a horizontal direction and transmit relatively
little energy directly toward the ground.
FCC/LSGAC Local Official’s Guide to RF
Table B1-3. Estimated "worst case" horizontal* distances that should be maintained from a single
sectorized Broadband PCS base station antenna to meet FCC RF exposure guidelines
1 1.6 1.7
5 8.2 3.8
10 16.4 5.4
25 41 8.6
50 82 12.1
For intermediate values not shown on this table, please refer to the Figure B1-3
*These distances are based on exposure at same level as the antenna, for example, on a rooftop or in a building directly across
from and at the same height as the antenna.
Note: These estimates are "worst case," assuming a sectorized antenna using 21 channels. If the system is using fewer than 21
channels, the actual horizontal distances that must be maintained will be less. PCS sectorized antennas transmit more or less
in one direction from the antenna in a horizontal direction and transmit relatively little energy directly toward the ground.
Therefore, these distances are even more conservative for “non-horizontal” distances, for example, distances directly below
an antenna.
FCC/LSGAC Local Official’s Guide to RF
Figure B1-3. Estimated "worst case" horizontal* distances that should be maintained from a
single sectorized, PCS base station antenna to meet FCC RF exposure guidelines
110
(Based on maximum total of 21 channels per sector)
100
Effective Radiated Power Per Channel (watts)
90 0.5 watt/channel
1 watt/channel
80 5 watts/channel
10 watts/channel
70 25 watts/channel
50 watts/channel
60 100 watts/channel
50
40
30
20
10
0
0 2 4 6 8 10 12 14 16 18
* These distances are based on exposure at same level as antenna, for example, on a rooftop or in a building directly
across from and at the same height as the antenna.
Note: These estimates are "worst case", assuming a sectorized antenna using 21 channels. If the systems are
using fewer channels, the actual horizontal distances that must be maintained will be less. PCS sectorized
antennas transmit more or less in one direction from the antenna in a horizontal direction and transmit relatively
little energy directly toward the ground.
FCC/LSGAC Local Official’s Guide to RF
Table B1-4. Estimated "worst case" horizontal* distances that should be maintained from a single
omnidirectional paging or narrowband PCS antenna to meet FCC RF exposure guidelines. Note:
this table and the associated figure only apply to the 900-940 MHz band; paging antennas at other
frequencies are subject to different values.
50 82 3.4
For intermediate values not shown on this table, please refer to the Figure B1-4
*These distances are based on exposure at same level as the antenna, for example, on a rooftop or in a building directly across
from and at the same height as the antenna.
Note: These distances assume only one frequency (channel) per antenna. Distances would be greater if more than one channel is
used per antenna. Omnidirectional paging and narrowband PCS antennas transmit more or less equally from the antenna in all
horizontal directions and transmit relatively little energy toward the ground. Therefore, these distances are even more
conservative for “non-horizontal” distances, for example, distances directly below an antenna.
FCC/LSGAC Local Official’s Guide to RF
Figure B1-4. Estimated "worst case" horizontal* distances that should be maintained from a single
omnidirectional paging or narrowband PCS antenna to meet FCC RF exposure guidelines.
Note: this figure and the associated table only apply to the 900-940 MHz band; paging antennas
at other frequencies are subject to different values
3,500
Effective Radiated Power (watts)
2,000
(Based on one channel per antenna)
1,000
500
25 watts/antenna
50 watts/antenna
250 100 watts/antenna
250 watts/antenna
100 500 watts/antenna
1000 watts/antenna
2000 watts/antenna
50 3500 watts/antenna
25
0 5 10 15 20 25 30
* These distances are based on exposure at the same level as the antenna, for example, on a
rooftop or building directly across from and at the same height as the antenna.
Note: These distances assume only one frequency (channel) per antenna. Distances would be greater if
more than one channel is used per antenna. Omnidirectional paging and narrowband PCS antennas
transmit more or less equally from the antenna in all horizontal directions and transmit relatively little
energy towards the ground.