APPLICATION TO SOLWAY HERITAGE

FOR FUNDING FROM THE LANDFILL COMMUNITIES FUND (LCF)

APPLICATION FORM FOR OBJECT A

Reclamation of Land

The remediation or restoration of land, which cannot now be used because of a ceased activity.

This form helps Solway Heritage understand more about your proposed project and to determine if it is eligible for funding. If the project is approved by Solway Heritage’s Board of Directors, the information in the form will be used by Solway Heritage when completing the registration form to seek approval for the project from ENTRUST.

Solway Heritage’s project appraisal and approval process is explained in the Guidance Notes, together with the circumstances under which it is able to offer grant funding.

Please ensure that you provide full and relevant details otherwise there could be delays in processing your application.

Please type or complete the form in black ink.

Check that you have enclosed, where relevant:

§  A Site Plan

§  Copies of any Planning Permission or other Consents, e.g. landowner permission

§  Letters of Support and any proof of match funding

§  Copies of any Orders, Agreements or Notices affecting the project site

§  Copies of quotes / tenders for goods or services

To assist in processing, please send your application by email to:

or

and send a hard copy of the last page with original signatures by post to:

Solway Heritage, 116 Drumlanrig Street, Thornhill, DG3 5LS

If you do not have access to email, please send the entire completed form to Solway Heritage at the above address.


APPLICANT’S DETAILS

Name of Applicant / Organisation

Legal Status of Organisation (including Registration Numbers)

Is the Organisation a Registered Environmental Body?

Yes / No / If Yes, please give your registration number

Correspondence Address

Landline Telephone Number Mobile Telephone Number

E-mail Address

Website Address

PROJECT DETAILS

Title of the Project

Please give a brief summary of the aims of your project

Estimated Start Date Estimated End Date

Project Location - Project Address Project Postcode

FINANCIAL DETAILS

Please list the expected items of expenditure and give the approximate total cost of the project (please use a separate sheet if necessary)

Item / Expenditure
Total

Will any of the Landfill funds be used to purchase capital assets?

(An asset is an item of economic value, especially that which could be converted to income.)

If yes, please detail the asset, cost and proportion being purchased with LCF?

How will the project be funded? Please state if the funding has been agreed.

(If funding has not been agreed, please state whether refused, or not yet decided)

Source of funds / Amount / Approved Yes / No

How much money do you need from Solway Heritage?

Will you receive in-kind assistance?

(e.g. subsidised accommodation or equipment) If so, please describe.

Will any income be generated by the project?

Yes / No / If Yes, how much?

If Yes, how will the income be generated?

Are you VAT registered?

Yes / No / If Yes, please give your VAT registration number
If Yes, are you able to reclaim VAT
on this specific project? / Yes / No

Would you prefer payment by cheque or directly to your account by BACS?

BACS is preferred
Bank Name
Account Name
Sort Code
Account Number
Cheque is preferred
Make cheque payable to

Who will provide the third party contribution?

Please outline any connected parties involved in undertaking the project

(A connected party is defined as any individual or organisation, related or linked to Solway Heritage)

Who will benefit from the project?

Who will carry out the work?

Please state if you carried out a competitive tendering exercise or how you selected who will undertake the work.

Please provide copies of all tenders and/or quotes with your application, or explain why these cannot be provided.


VALUE AND VOLUNTEERING

Where applicable, will the project use any type of recycled material? / Yes / No
Where applicable, please estimate the number of new or existing jobs as a result of the development of this project.
Where applicable, please estimate the number of full-time jobs that will be created or maintained once the project has been completed.
Where applicable, please estimate the number of part-time jobs (less than 18 hours/week) that will be created or maintained once the project has been completed.
Where applicable, please estimate the number of people who will obtain training qualifications or recognised skills, directly linked to the development of this project.
Please estimate the number of users that currently use the site per year.
(1 user = 1 person who may visit the facility more than once per year.)
(1 person visiting the facility 10 times in a year = 1 user.)
Please estimate the number of users that will use the site per year after the project has been completed.
Please estimate the current footfall of the site per year.
(Footfall counts every visit.)
(1 person visiting the facility 10 times in a year = footfall of 10.)
Please estimate the footfall of the site after the project has been completed.
Where applicable, please estimate the number of schools which currently visit the site.
If you anticipate that the project will increase school visits once completed, please estimate by how many.
What is the total value of LCF funding that will be used to make improvements or provide improved facilities for people with disabilities?
Will this project make changes which will result in improving energy efficiency? / Yes / No
Please estimate total utility cost saving of the project per annum once the project is complete.
Number of volunteers expected to help in the delivery of this LCF project.
(A volunteer is someone who has offered their time to participate in the project and will receive nothing more than reasonable out-of-pocket expenses whilst carrying out works on the project site.)
Number of youth volunteers working on this project.
(A youth is someone who is between the ages of 16 – 25 when they start working on a project.)
Number of youth volunteering days created by this project.
If you are improving areas of land (excluding land for building development), please estimate the number of hectares that will be worked on as part of this project.
If you intend to plant trees as part of this project, please estimate how many will be planted?

SUPPLEMENTARY INFORMATION

What is the name of the closest landfill site to the project

How far is the project site from the

nearest landfill site in miles Postcode of the closest landfill site

What is the name of the project site?

What activity previously took place on this land, which caused it to need the work proposed?

When did this activity stop?

What is the name of the person or organisation that carried out this activity or allowed it to be carried out?

What work will you be carrying out to bring this land back into use?

The restoration / The remediation
Reclamation / Other, please outline

When you have finished the works, what will the end land use be?

Social or Environmental (e.g. Nature Reserve or public park)
Economic (e.g. used in redevelopment)

If applicable, please estimate the number of metres of footpath and / or bridle ways or cycle paths which will be provided.

Has a District Valuation Office Valuation been undertaken on the land?

(You should have the land independently valued)

YES / NO

If no, please explain why

When will the valuation take place?

What is the value of the land now (to the nearest £1,000)?

What will be the estimated land value upon completion of this project (to the nearest £1,000)?

What will you be doing to ensure the uplift in value is recouped by the EB (Solway Heritage)?

Does the individual or organisation who undertook the polluting of the land still have any interest in the land through ownership, lease, freehold or otherwise?

YES / NO

If Yes, please give the reason why this person or organisation will not benefit from your remediation work?

Please describe briefly the nature of the work you propose to do, saying how it will bring the land back into use?

Does the landowner own any land adjacent to the project site?

YES / NO

Does the EB (Solway Heritage) or contributor have any contractual relationship or other connection with the owner of the land?

YES / NO

If yes, state the nature of the relationship or connection.

Are there any outstanding notices or orders affecting the site under Section 46A of the Control of Pollution Act 1974 or Sections 13, 14, 26 and 78E of the Environmental Protection Act 1990 or Sections 90B and 161A of the Water Resources Act 1991?

YES / NO

Is the work you propose required by a condition of any planning permission?

YES / NO

Is the work required by a condition of the terms of any agreement involving your contributor(s) under Section 106 of the Town and Country Planning Act 1990, Section 75 of the Town and Country Planning Act (Scotland) 1997 or Article 40 of the Planning (Northern Ireland) Order 1991?

YES / NO

It is a requirement of both Solway Heritage’s Board of Directors and ENTRUST that the use of Landfill Tax Credits and the involvement of Solway Heritage is acknowledged in any publicity for the project. Please state how you plan to publicise and promote the project and how this requirement will be met.

(please provide as much information as possible and attach additional sheets if necessary)

Other Relevant Information

(Any other information you wish to provide which is not covered above - please attach separate sheet if necessary)

MONITORING INFORMATION

How did you find out about Solway Heritage and the Landfill Communities Fund?


DECLARATION

Please confirm each of the following statements by ticking the boxes and signing the Declaration below.

I confirm that any income earned by this project will either be re-invested in the running of the project or returned to Solway Heritage, as Environmental Body, as funding derived from the Landfill Communities Fund.
I confirm that any assets or proportion of assets purchased with Landfill monies will be protected to ensure that any subsequent sale or disposal does not result in the Landfill monies being lost from the Fund.
I confirm that any Contributing Third Party funding will neither be made up of Landfill monies nor derive a unique benefit from the project going ahead.
I confirm that there will be no benefit to any Landfill Operator who has made a contribution to the Environmental Body.
I confirm that there will be no benefit to the person who carried out the ceased activity.
I confirm that the project is not required as part of the following
Notices or Orders:
(a)  A Works Notice served under Section 46A of the Control of Pollution Act 1974;
(b)  An Enforcement Notice served under Section 13 of the Environmental Protection Act 1990;
(c)  A Prohibition Notice served under Section 14 of the Environmental Protection Act 1990;
(d)  An Order under Section 26 of the Environmental Protection Act 1990;
(e)  A Remediation Notice served under Section 78E of the Environmental Protection Act 1990.
I confirm that the project is not a condition of any planning permission or any statutory consent arising from an application of a contributing Landfill Operator.
I confirm that the project is not a term of an agreement made under either:
I confirm that the project is not a term of Agreement made under either:
·  Section 106 of the Town and Country Planning Act 1990
·  Section 75 of the Town and Country Planning Act (Scotland) Act 1997
·  Article 40 of the Planning (Northern Ireland) Order 1991
To which the contribution Landfill Operator is a party.
I confirm that, where appropriate, I have carried out a completive tendering exercise or obtained competitive quotes.
I confirm that I will inform Solway Heritage of any change in project aim, duration or expenditure after approval has been granted.

DECLARATION

Two ORIGINAL signatures must be provided

I declare that to the best of my knowledge and belief, the information on this Application Form is true.

We are authorised by (name of organisation)

...... ………………………………………………...to sign this declaration.

Signature …………………………………………………………………………..

Print Name …………………………………………………………………………..

Job title …………………………………………………………………………..

Date …………………………………………………………………………..

Signature …………………………………………………………………………..

Print Name …………………………………………………………………………..

Job title …………………………………………………………………………..

Date …………………………………………………………………………..

Data Protection

The information provided on this form will be used only for the purposes of determining the application and personal information will not be disclosed to any other party.

LCF App – Obj A 12 Last updated – June 2014