Additional Capacity Request Form

Application For Additional Capacity For Household Waste

By completing the form below you are requesting additional capacity for your household waste. If you are successful in meeting the qualifying criteria you will be allocated a bin as listed in the table below.
The Council will consider each application on its merits and will only allocate an additional bin if you use the kerbside recycling service or recycling sites throughout the Borough.

Qualifying Criteria	Additional Bin Provided	Waste Items That Can Be Disposed Of In The Bin
6 Permanent Residents	140L bin with a black lid	Household Waste
5 Permanent Residents with 1 child under the age of 3 in nappies	140L bin with a yellow lid (the lid will say nappies only)	You can only put nappies into the 140L yellow lid bin. This bin will not be emptied if it contains other household waste. Please do not place nappy waste inside black bin bags. Please use either white bin liners / old carrier bags.
Special Medical Circumstances	140L bin with a yellow lid (the lid will say nappies only)	You can only put medical waste into the 140L yellow lid bin. This bin will not be emptied if it contains other household waste. Please do not place medical waste inside black bin bags. Please use either white bin liners / old carrier bags.

As part of the application process a home visit will be carried out by a waste monitoring officer upon receipt of your application form. Please include a contact number on the form so that an appointment can be booked with you.

If you qualify for additional capacity you will be notified within 10 working days.

*Please note, if you are applying for additional capacity due to medical reasons you will need to provide a letter and signature from your District Nurse, Health Visitor or Care Worker to validate your request.

Declaration

By submitting the form below you are declaring that the information in the form is a true representation of your current circumstances. You must understand that giving false information will result in the cancellation of your additional capacity service. If your circumstances change you must inform the Waste Management Team immediately on 01773 841326.

Additional Capacity

PERSONAL DETAILS

Title

First Name(s)

Surname

Contact Number

Email Address

Address

If the property is in the Amber Valley area please enter the postcode or the first few letters of the street. Otherwise enter the full address in the box below.

DETAILS OF PERMANENT RESIDENTS IN YOUR HOUSEHOLD

How many permanent residents are in your household?

Please state all the full names of the residents:

REASON FOR REQUESTING ADDITIONAL CAPACITY

1. I have a child under 3 years old and use disposable nappies

Yes
No

If yes, how many children are in nappies?

Please state the age(s) of children in nappies

2. I have more than 5 permanent residents in my household

Yes
No

3. I have special medical circumstances that result in the production of more waste than usual

Yes
No

If yes, please give details

DECLARATION

Please confirm if you agree to the declaration detailed above

Yes
No

FOR OFFICE USE ONLY

Visiting Officer:

Visiting Officer Signature:

Date of Visit:

Does the customer qualify? Yes / No

Customer: Print Name

Customer: Sign

Application For Additional Capacity For Household Waste

Declaration

Additional Capacity

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