A septic system evaluator on inactive status or whose license to practice in this state has been lapsed for a period of 12 months or more shall:

1. (a) Complete and submit a “Septic System Evaluator Reinstatement” form, revised September 2018, to the board that shall include at least the following:

   1. (1) The applicant’s full name;
   2. (2) The date the applicant’s initial license was issued and the license number;
   3. (3) The applicant’s business address and telephone number;
   4. (4) The applicant’s home address and telephone number;
   5. (5) The applicant’s email address;
   6. (6) Documentation that the applicant has complied with the continuing education requirements of Sep 403;
   7. (7) A statement indicating any disciplinary action brought against the applicant;
   8. (8) A statement indicating whether the applicant has ever been convicted of any felony, any misdemeanor, or a violation and if so, the name of the court, the details of the offense, and the date of conviction and the sentence imposed;
   9. (9) A statement indicating that to their knowledge the applicant has adhered to the ethical and professional standards of RSA 310-A:205 and Sep 500;
   10. (10) A representation that the applicant acknowledges that the provision of false information in the application is a basis for disciplinary action by the board; and
   11. (11) The applicant’s signature and date; and
2. (b) Applicants shall submit the application and reinstatement fees as specified in Sep 301.03.

Source. #12654, eff 10-31-18