Household level wastewater management and disposal data collection in the U.S.: the history, shortcomings, and future policy implications

Abstract

Country-level sanitation access is monitored globally by the Joint Monitoring Programme (JMP). However, recent reports on sanitation access in high-income countries indicate that the JMP data may underestimate the prevalence of unsafely managed sanitation in these settings. This study explains the surveys that collect household-level wastewater management data in the U.S. and analyzes the accuracy and reliability of these data sets. From 1940 to 1990, sewage disposal data were collected comprehensively through the U.S. Decennial Census. These data are currently collected through the American Housing Survey (AHS) which appears to greatly underestimate the usage of onsite wastewater treatment systems (OWTS). In addition to these surveys, we highlight current efforts to introduce a sewage disposal question to the American Community Survey (ACS), localized efforts to collect wastewater data, and the Point-in-Time count of people experiencing homelessness. Using estimates of OWTS usage in new housing, this study provides the first defensible national estimate of OWTS usage since 1990. We estimate that 25.03% of U.S. households use OWTS which exceeds the AHS estimate (15.7%) by over 12 million households. This study discusses the potential for better wastewater data collection to inform future wastewater policy and improve the quality of life for U.S. residents.
HIGHLIGHTS
The Decennial U.S. Census collected sewage disposal data until 1990 with no recent representative data.;
We estimate 32.2 million U.S. housing units (25.03%) use onsite wastewater treatment systems (OWTS) based on data from the Decennial Census and new housing.;
Accurate data are needed to inform allocation of federal funding, but current data under-represent residents without access to safely managed sanitation.;

Full text

Household level wastewater management and disposal data collection in the
U.S.: the history, shortcomings, and future policy implications
Jillian Maxcy-Brown a,*, Mark A. Elliott aand Bennett Beardenb
a
Department of Civil, Construction and Environmental Engineering, University of Alabama, Tuscaloosa, AL 35487, USA
b
Geological Survey of Alabama, 420 Hackberry Lane, Tuscaloosa, AL 35486, USA
*Corresponding author. E-mail: jmaxcybrown@crimson.ua.edu
JM-B, 0000-0002-0918-1640; MAE, 0000-0002-7835-0612
ABSTRACT
Country-level sanitation access is monitored globally by the Joint Monitoring Programme (JMP). However, recent reports on
sanitation access in high-income countries indicate that the JMP data may underestimate the prevalence of unsafely managed
sanitation in these settings. This study explains the surveys that collect household-level wastewater management data in the
U.S. and analyzes the accuracy and reliability of these data sets. From 1940 to 1990, sewage disposal data were collected com-
prehensively through the U.S. Decennial Census. These data are currently collected through the American Housing Survey (AHS)
which appears to greatly underestimate the usage of onsite wastewater treatment systems (OWTS). In addition to these sur-
veys, we highlight current efforts to introduce a sewage disposal question to the American Community Survey (ACS),
localized efforts to collect wastewater data, and the Point-in-Time count of people experiencing homelessness. Using estimates
of OWTS usage in new housing, this study provides the first defensible national estimate of OWTS usage since 1990. We esti-
mate that 25.03% of U.S. households use OWTS which exceeds the AHS estimate (15.7%) by over 12 million households. This
study discusses the potential for better wastewater data collection to inform future wastewater policy and improve the quality
of life for U.S. residents.
Key words: Census survey questionnaires, Decentralized wastewater treatment, Environmental justice, Onsite wastewater
treatment, Sustainable development goals, Wastewater access data
HIGHLIGHTS
•The Decennial U.S. Census collected sewage disposal data until 1990 with no recent representative data.
•We estimate 32.2 million U.S. housing units (25.03%) use onsite wastewater treatment systems (OWTS) using data from the
Decennial Census and new housing.
•Accurate data are needed to inform allocation of federal funding, but current data under-represent residents without access
to safely managed sanitation.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Licence (CC BY 4.0), which permits copying,
adaptation and redistribution, provided the original work is properly cited (http://creativecommons.org/licenses/by/4.0/).
© 2023 The Authors Water Policy Vol 00 No 0, 1 doi: 10.2166/wp.2023.147
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GRAPHICAL ABSTRACT
INTRODUCTION
By 2030, the United Nation’s Sustainable Development Goal 6.2 strives to enable ‘access to adequate and equi-
table sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and
girls and those in vulnerable situations’(United Nations, 2015). Currently, sanitation service access is tracked
globally through the World Health Organization (WHO) and the United Nations Children’s Fund’s (UNICEF)
Joint Monitoring Programme (JMP). The JMP uses a five-level service ladder (open defecation, unimproved, lim-
ited, basic, and safely managed) to evaluate sanitation access for countries throughout the world. Whereas many
low-income countries have externally funded household surveys like the Demographics and Health Survey
(DHS) or Multiple Indicator Cluster Survey (MICS) (United States Agency for International Development
et al., 2021), most high-income countries self-report data for the JMP (e.g., from results of a question on a national
census). However, these data and corresponding survey questions do not necessarily align with the five service
levels of sanitation access that are used for JMP reporting and monitoring of sanitation access. In addition to
this misalignment, there are numerous other limitations present for data from high-income countries as a
result of deprioritizing the collection of household-level wastewater data (Sato et al., 2013;US Water Alliance
and DigDeep, 2019;Maxcy-Brown et al., 2021) and underrepresenting historically excluded communities
(Capone et al., 2020;Mattos et al., 2021b;Maxcy-Brown et al., 2021). It is essential to have a reliable means
to collect wastewater access data for measuring the current types of wastewater management strategies,
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identifying households that need access improvements, and tracking progress toward achieving equitable access
to safely managed sanitation.
In the United States, wastewater (or sewage disposal) access data have historically been collected through sur-
veys administered to individuals and households by the U.S. Census Bureau. These surveys collect data on the
type of sewage disposal method that housing units have access to, including public sewer, onsite wastewater treat-
ment systems (OWTS), other means, or no system. These data are reported to JMP to determine estimates for the
number of persons within each service access level. The U.S. Decennial Census long-form collected basic waste-
water data until 1990 (U.S. Census Bureau, 1990,2000). Currently, the U.S. Census Bureau collects wastewater
data for U.S. residents through the American Community Survey (ACS) and the American Housing Survey
(AHS). Both the ACS and AHS collect data on indoor plumbing, but only the AHS currently collects data on
sewage disposal. The most recent JMP uses data from the 2019 AHS to report that 98.3% of U.S. residents
have access to safely managed sanitation while 1.4% of residents have basic sanitation access and 0.3% of resi-
dents have unimproved sanitation access (about 1.1 million people) (WHO & UNICEF, 2020). Safely
managed sanitation access data for the U.S. is reported for ‘Total’and ‘Urban’while ‘Rural’is only reported as
‘at least basic’(WHO & UNICEF, 2020) which indicates no capacity to differentiate between basic or safely man-
aged sewage disposal methods in rural areas. The JMP data for the U.S. reports that there are zero residents who
rely on limited service or open defecation (WHO & UNICEF, 2020). This is a misrepresentation of the sanitation
situation in the U.S. because it clearly does not account for the estimated 580,000 persons experiencing home-
lessness each night (Department of Housing and Urban Development, 2023) who rely on shared facilities
(limited sanitation access) or open defecation, nor does it include the households without at least basic waste-
water management who rely on incomplete indoor plumbing (US Water Alliance and DigDeep, 2019), failing
septic systems (Siddoway, 1988), straight pipes (Maxcy-Brown et al., 2021), cesspools (State of Hawaii Depart-
ment of Health, 2021), failing outhouses (US Water Alliance and DigDeep, 2019), and bucket latrines
(Eichelberger, 2018). The scope of this paper does not include the evaluation of monitoring centralized waste-
water collection and treatment systems including combined sewer overflows (CSOs), sanitary sewer overflows
(SSOs), and National Pollutant Discharge Elimination System (NPDES) permit compliance.
This paper focuses on household (or individual) level data collection with the specific objectives to (1) evaluate
the current surveys collecting wastewater data in the U.S. that are administered by the federal government
(through the U.S. Census Bureau and the U.S. Department of Housing and Urban Development), (2) discuss
other surveys that have been used to collect wastewater data in the U.S., (3) provide the first defensible estimate
of nationwide OWTS use since the 1990 Census, (4) look toward the future of wastewater data collection in the
U.S., and (5) inform the trajectory for future wastewater policy.
U.S. DECENNIAL CENSUS
The U.S. Decennial Census collected data on the means of household wastewater (sewage) disposal from 1970
until 1990 (Figure 1), after which the question was removed (U.S. Census Bureau, 1990,2000,2021a;Maxcy-
Brown et al., 2021). The U.S. Decennial Census long-form (delivered to roughly 20% of U.S. households) col-
lected nationwide information on wastewater disposal using one question (H16 in 1990, Table 1), which
allowed the resident to choose three options for their wastewater management: (1) public sewer, (2) septic
tank or cesspool, or (3) other means (U.S. Census Bureau, 1990). The 1990 long-form Census data are certainly
useful, but they are over 30 years out-of-date and interpreting responses can be challenging. It is important to note
that this question is focused on the means of wastewater disposal and not the proper functionality of the treat-
ment system.
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The trends in sewage disposal between 1970 and 1990 showed a slight increase in the proportion of the U.S.
population on public sewer (71.2–74.8%) while septic tank or cesspools stayed relatively steady (24.5–24.1%) and
other means decreased (4.3–1.1%). In the 1990 Decennial U.S. Census, roughly 208 million residents (76.5
million households) were connected to public sewer for wastewater management (U.S. Census Bureau, 1993,
1995). There were also roughly 67 million residents (24.7 million households) who relied on septic tanks or cess-
pools for wastewater management and roughly 3 million residents (1.1 million households) who relied on other
means (U.S. Census Bureau, 1993,1995).
In question H16, the answer ‘connected to public sewer’the household level data are not connected to any data
on the proper disposal of wastewater after it leaves the household and is conveyed via public sewer to a centra-
lized treatment plant. Considering the U.S.’s history of CSOs and SSOs which discharge large quantities of
untreated or incompletely treated wastewater (Burian et al., 2010;Potera, 2018;Botturi et al., 2020;U.S. EPA,
2020,2021a;Prevost, 2022), it is not a reasonable assumption to conclude that all households with connections
to public sewer have access to safely managed sanitation even though this is often how the data are reported to
Fig. 1 |Summary timeline of U.S. surveys collecting sewage disposal and indoor plumbing data.
Table 1 |U.S. Decennial Census questions on sewage disposal (U.S. Census Bureau, 1990).
H16: Is this building connected to a public sewer?
•Yes, connected to public sewer
•No, connected to septic tank or cesspool
•No, use other means
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JMP. Centralized wastewater system performance is monitored through NPDES permits and state-level spill
reporting but these are beyond the scope of this paper’s focus on wastewater data collection at the household
level.
The question H16 answer ‘No, connected to septic tank or cesspool’did not clearly differentiate failing, unper-
mitted OWTS from functioning, permitted OWTS (Maxcy-Brown et al., 2021). The questionnaire did provide a
section with instructions that stated ‘A septic tank or cesspool is an underground tank or pit used for disposal
of sewage’(U.S. Census Bureau, 1990), but these instructions did not clarify the method for discharge from
the septic tank/cesspool. It is important to note that cesspools are not designed to treat wastewater and are
not recognized as treatment systems by the U.S. Environmental Protection Agency (U.S. EPA, 2021b). The
answer choice only asks about the container to which the wastewater is conveyed and neither option included
is able to independently treat the wastewater properly. A septic tank should be followed by a drainfield for infil-
tration and pathogen removal, but this question is unable to clarify if this is the case. It is likely that many with a
flush toilet and no sewer connection are simply unaware of the means of sewage disposal at their residence and
assume that it is a proper septic system (Nasim et al., 2023).
The final option for H16 ‘No, use other means’was meant to capture primarily the use of outhouses, but would
also include a variety of wastewater disposal methods like straight pipes, composting toilets, and honeybuckets
(buckets with toilet seats attached). Any disposal method that is captured in this answer choice is likely to be con-
sidered not safely managed and a direct threat to human and environmental health. The quantity of residents
relying on ‘other’wastewater management strategies had decreased greatly in the decades before 1990 as out-
houses were being replaced with indoor plumbing, but there are still populations today that do not have
access to proper wastewater disposal.
The U.S. Decennial Census long-form collected data on indoor plumbing from 1940 to 2000 (Figure 1) after
which the long-form questionnaire was excluded from the 2010 or 2020 Decennial Census and a version of ques-
tion H10 (Table 2) was instead included on the ACS (U.S. Census Bureau, 2000,2021a;Herman, 2008). From
1940 to 1970, the Decennial Census asked about each plumbing facility individually, which enabled tracking
access to flush toilets in the U.S. (U.S. Census Bureau, 2021a). In 1940, flush toilet data was collected for 48
states and Washington, DC (no data for Alaska or Hawaii) and found that 12 million housing units (35.3% of
U.S. housing units) did not have a flush toilet with 20 states that had over 50% of housing units lacking a
flush toilet (U.S. Census Bureau, 2021a). Starting in 1950, data were collected for all 50 states and Washington,
DC (U.S. Census Bureau, 2021a). By 1960, 6 million housing units were without a flush toilet (10.3%) and only 8
states had over 25% of housing units without a flush toilet (U.S. Census Bureau, 2021a). When the Decennial
Census combined the plumbing facilities into one question (such as Question H10 from the 1990 Decennial
Census), the data were still relevant for understanding the potential for the use of certain wastewater disposal
methods that do not use a flush toilet (e.g., bucket latrines and outhouses), but it was focused on ‘complete plumb-
ing’which no longer allowed the respondent to clarify which aspect of the plumbing facility is lacking; thus, it is
Table 2 |U.S. Decennial Census questions on indoor plumbing (U.S. Census Bureau, 1990).
H10: Do you have COMPLETE plumbing facilities in this house, apartment, or mobile home; that is, (1) hot and cold piped
water, (2) a flush toilet, and (3) a bathtub or shower?
•Yes, have all three facilities
•No
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impossible to determine which percentage of homes lacked a flush toilet. In 1990, there were 1.1 million housing
units (1.1%) that did not have access to complete plumbing facilities (U.S. Census Bureau, 2021b).
AMERICAN COMMUNITY SURVEY
Starting in 2005, the U.S. Census Bureau began administering the ACS annually (Figure 1). The ACS currently
samples approximately 3.54 million households each year, with a single address not being sampled more than
once every 5 years (Herman, 2008;Capone et al., 2020;U.S. Census Bureau, 2021c,2022a). The data are cur-
rently available in 1-year and 5-year estimates; while the 5-year samples have the largest sample size and are
considered the most reliable, they include data aggregated across the previous 5 years and are thus not as up-
to-date as the most recent annual data (U.S. Census Bureau, 2022b). Annual data are reported for geographic
entities with at least 65,000 people while supplemental one-year data is released for areas with 20,000 or
more people and areas with fewer than 20,000 people are only available in 5-year estimates (Hertz Hattis,
2020). In 2021, there were 3,538,442 initial addresses selected and data were collected from 1,950,832 interviews
(U.S. Census Bureau, 2021d). Each surveyed household is given a household weight that represents the quantity
of households represented by that household’s data and each individual within the household is also assigned
person weight that reflects the population represented by that individual’s data (Ruggles et al., 2022). The
ACS form that is distributed to individual households collects data on access to indoor plumbing and the cost
of water and sewer (Table 3), but the form distributed to group quarters (e.g., nursing facilities, college/university
student housing, correctional facilities, and barracks) does not include these questions (U.S. Census Bureau,
2023).
The ACS currently asks about indoor plumbing (Table 3), but the information is limited due to a 42% nonre-
sponse rate for this question (based on 2017 5-year estimates) which is quite high when compared to a ,3%
nonresponse rate for other household plumbing questions (Capone et al., 2020). In 2016, the ACS removed
flush toilet as an answer choice, precluding tracking changes past 2015 (U.S. Census Bureau, 2015a,2016).
The 5-year estimates for 2011–2015 estimate that there are 782,084 residents in the U.S. (or 0.25% of the U.S.
population) who do not have access to a flush toilet (Ruggles et al., 2022). The states with the largest percentages
of residents without flush toilets were Alaska (1.04%), New Mexico (0.69%), Arizona (0.42%), Maine (0.42%),
and Alabama (0.41%) (Ruggles et al., 2022). Although the ACS asks about the cost of water and sewer over
the past 12 months (Table 3), it does not clarify if the services are affordable, reliable, and functioning properly
Table 3 |2023 ACS questions related to water and wastewater access (U.S. Census Bureau, 2023).
Does this house, apartment, or mobile home have–Yes No
a. hot and cold running water?
b. a bathtub or shower?
c. a sink with a faucet?
d. a stove or range?
e. a refrigerator?
flush toilet? (removed in 2016)
In the past 12 months, what was the cost of water and sewer for
this house, apartment, or mobile home? If you have lived here
less than 12 months,
estimate the cost.
Past 12 months’cost –Dollars
$ X,XXX.00
Or
oIncluded in rent or condominium fee
oNo charge
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(US Water Alliance and DigDeep, 2019). As of 2023, the ACS does not include questions about wastewater dis-
posal method.
The U.S. Census Bureau considers anything not urban to be rural areas (Ratcliffe et al., 2016). Urban areas
are assessed at the census block level (smallest geographical unit for the U.S. Census Bureau surveys) based on
total population thresholds and densities, land use, and development distance (Ratcliffe et al., 2016). Urbanized
areas have total populations of more than 50,000 people while urban clusters have between 2,500 and 50,000
people (Ratcliffe et al., 2016). An urban area must have a population density of at least 1,000 people per square
mile or 500 people per square mile if the block contains nonresidential land use (Ratcliffe et al., 2016). Land
use considers land cover and impervious surfaces that are within a quarter mile of an urban area (Ratcliffe
et al., 2016). For development distance, there is a hop criteria that determines if an area is within half a
mile from urban development along a road corridor (Ratcliffe et al., 2016). The U.S. Census Bureau delineates
Core-Based Statistical Areas or Metropolitan and Micropolitan areas for statistical purposes with the remaining
areas considered nonmetropolitan areas (Ratcliffe et al., 2016). Nonmetropolitan areas are often considered
synonymous with rural, but these geographical entities only have some overlap and are not identical (Ratcliffe
et al., 2016). Counties are listed as completely rural, mostly rural, or mostly urban with the classifications
updated following each Decennial Census (Ratcliffe et al., 2016). The annual ACS data will be updated the
second year after the Decennial Census and will continue to use that classification for a decade (Ratcliffe
et al., 2016).
AMERICAN HOUSING SURVEY
The AHS is the biennial survey that is sponsored by the U.S. Department of Housing and Urban Development
(HUD) and administered in odd-numbered years by the U.S. Census Bureau (Figure 1;U.S. Census Bureau,
2020a;Table 4). This longitudinal survey aims to collect responses from the same households with new represen-
tative national samples being determined every 10 years or so (U.S. Census Bureau, 2019,2020a,2022c). Starting
in 2015, there were about 115,000 households selected to participate until 2025 or until a new sample is drawn
(U.S. Census Bureau, 2022d). This sample set includes a base sample of approximately 85,000 housing units for
the national sample and additional housing units for an oversampling of select metropolitan areas and HUD-
assisted housing units (U.S. Census Bureau, 2022d). The goal of each survey is to generate nationally representa-
tive data, but budget constraints typically only allow for samples from 30 metropolitan areas (U.S. Census Bureau,
2022d). The survey has four strategic goals and the first one is to ‘provide data to measure the quality, accessibil-
ity, and resiliency of the housing stock’which includes the housing unit’s physical adequacy based partly on the
unit’s plumbing and sewage disposal (U.S. Department of Housing and Urban Development et al., 2020). The
Table 4 |2021 AHS sample sets (U.S. Census Bureau et al., 2022a,2022b).
Sample set for 2021
Total selected
housing units
Housing units that were
determined to be ineligible
Housing units that
were surveyed
Housing units that
completed survey
Overall
response rate
Integrate National
Sample
95,295 2,295 93,000 64,141 69%
Independent
Metropolitan Area
Samples
82,504 1,733 80,771 54,632 68%
Total 177,799 4,028 173,771 118,773
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AHS asks questions regarding both sewage disposal and indoor plumbing (Table 5 and Supplementary Table S1)
in the ‘core’data, but also has a series of ‘topical’data questions that rotate each time the survey is administered
(U.S. Census Bureau, 2022d) which could provide an opportunity for different questions to be introduced. The
2021 AHS asks questions regarding sewage disposal, indoor plumbing, toilet and sewage system breakdowns,
water and sewer utility costs, and utility shut-offs (Table 5 and Supplementary Table S1).
While AHS data are useful, the AHS is less comprehensive with reporting data only from only certain states
and select metropolitan areas, representing only 39% of urban populations in the U.S. (Capone et al., 2020). It
does not have an extensive sample of rural areas and does not sample group quarters like the ACS (US Water
Alliance and DigDeep, 2019;U.S. Census Bureau, 2022d). The households are assigned to a rural/urban/subur-
ban category when they first complete the survey without adjustments in subsequent years even though
metropolitan areas may grow such that some suburban respondents become urban and some rural become sub-
urban (NOWRA, 2017) before a new sample set is drawn; this results in a decreased proportion of rural
respondents over time (NOWRA, 2017).
Although the U.S. currently does not have a survey that is collecting wastewater data as comprehensively as the
Decennial U.S. Census, the AHS is the most recent national wastewater data set. It reported in 2021 that
108,574,000 housing units (84.5% of occupied housing units) are connected to public sewer and 19.5 million
housing units used septic tank systems or cesspools (15.2% of occupied housing units) (Table 6), but experts in
the onsite industry do not view these data as accurate (NOWRA, 2018;U.S. Census Bureau, 2021e;U.S. EPA,
2021c). The EPA does not consider cesspools to be adequate treatment systems since they are designed solely
for waste disposal without any intention to treat the waste, but the AHS categorizes septic tank systems with
Table 5 |2021 select AHS questions on sewage disposal and indoor plumbing (U.S. Census Bureau, 2022e).
Question ID Coded question Answer choices
PUBSEWQ Is ‘this building’(housing type) connected to a public sewer? 1. Yes
2. No
SEWDISV (Last time) we recorded that your (housing type) used
^ISEWDISTP septic tank or cesspool for sewage disposal. Is
this information still correct?
1. Yes
2. No
SEWDISQ What means of sewage disposal does ‘this building’(housing type)
have?
1. Septic tank
2. Cesspool
3. Chemical toilet
4. Outhouse or privy
5. Other; specify
6. None
SEWDISTP What type of septic tank or cesspool system do you have?
Read all answer categories.
Refer to the help screen for more details on the types of septic
tank or cesspool systems.
1. Standard septic tank and subsurface
leach field (most common type)
2. Uses a pump to distribute wastewater
3. Elevated above natural soil surface
4. Applies treated wastewater
5. Any type not listed above
TOILET2 Does ‘this building’(housing type) have a toilet? 1. Yes
2. No
Note: The questions are coded to autofill information. For ease of reading, ‘^your_the_that’was replaced with ‘this building’and ^HTYPEFILL was replaced with
(housing type).
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cesspools, making it difficult to use these data sets to determine if the households have an adequate decentralized
treatment system (U.S. EPA, 2021c).
Many residents are unaware of their sewage disposal method (unless they are paying a monthly sewer bill) as
may be the case with the 132,000 housing units with no reported sewage systems and the 185,000 housing units
classified as ‘other’(Table 6). The answer choice options for question coded SEWDISTP were (1) standard septic
tank and subsurface leach field (most common type), (2) uses a pump to distribute wastewater, (3) elevated above
natural soil surface, (4) applies treated wastewater, and (5) any type not listed above, but none of these would be
common knowledge to the average U.S. resident unless they were involved in the design and installation of their
OWTS. In addition, answer choice 1 being listed as the most common (Table 5) could potentially bias the inter-
viewee’s response. Of the housing units reported to be on septic tanks or cesspools, there were 320,000 units that
reported breakdown(s) in the last 3 months (Supplementary Table S3); the examples listed, which ‘could include
tank collapse or explosion and tank being unable to perk resulting in a pump out’indicate a deep lack of under-
standing of the functioning of septic systems by those who drafted the question (U.S. Census Bureau, 2021f).
Breakdown data is not collected for houses that are classified as ‘other’,‘none’, and ‘not reported’(444,000 hous-
ing units) (U.S. Census Bureau, 2021f). In 2015, the AHS survey added ‘none’as an option for wastewater system
and 199,000 homes were categorized under this option (U.S. Census Bureau, 2015b). In 2021, the number of
homes with ‘none’sewage system had decreased to 123,000, while the number of represented housing units
increased by 10.2 million (U.S. Census Bureau, 2015b,2019). It is also interesting to note that the data for
‘none’in 2017 did not meet publication standards and was withheld to avoid disclosure (U.S. Census Bureau,
2017). Although most of the data for incomplete bathrooms in 2021 also did not meet publication standards,
the AHS did report that 136,000 housing units were without a complete bathroom (flush toilet, bathtub or
shower, and a sink) and 116,000 housing units had no bathroom (U.S. Census Bureau, 2021f; Supplementary
Table S2).
The AHS uses the responses from the survey to classify housing units as adequate, moderately inadequate, or
severely inadequate; reasons including heating, electrical, upkeep, and also plumbing. Numerous plumbing con-
ditions will result in a housing unit being classified as moderately inadequate, including at least three occurrences
in the last 3 months of no functioning flush toilet for six or more hours, while some of the conditions for a housing
Table 6 |2021 National –plumbing, water, and sewage disposal –all occupied units (U.S. Census Bureau, 2021e).
Total (Households) 128,504,000
Type of sewage system
Public sewer 108,574,000
Septic tank or cesspool 19,489,000
Standard septic tank and subsurface leach field 18,371,000
Pump used to distribute wastewater 633,000
Elevated above natural soil surface 291,000
Applied treated wastewater 66,000
Other 128,000
Other 185,000
None 123,000
Not reported 132,000
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unit to be deemed severely inadequate are no hot or cold piped water, no full bathroom, or sharing a bathroom
with members from another household (U.S. Census Bureau, 2021f). In 2021, there were 6.7 million housing units
that were moderately or severely inadequate and over 2.5 million housing units that were without a functioning
flush toilet at some point in the 3 months before the survey was collected (Supplementary Table S3). The AHS
states that a flush toilet breakdown may be the result of ‘a faulty flushing mechanism, broken pipes, stopped
up sewer pipes, lack of water supplied to the flush toilet, or some other reason’including breakdowns due to natu-
ral disasters (U.S. Census Bureau, 2021f). It is shocking that a developed country would have roughly 6.6 million
residents (based on an average household size of 2.60 persons (U.S. Census Bureau, 2022f)) without access to a
flush toilet at some point during 2021.
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT POINT-IN-TIME (PIT) COUNT
SURVEY
The U.S. Department of Housing and Urban Development conducts a Point-in-Time (PIT) count in January
through its Continuum of Care (CoC) program in order to count people experiencing homelessness in both shel-
tered and unsheltered circumstances (U.S. Department of Housing and Urban Development, 2023). CoC is
required to annually count the number of people on a single night in emergency shelters, transitional housing,
and Safe Havens across the country which also includes domestic violence shelters and voucher-funded hotel
and motel rooms (Meyer et al., 2023;U.S. Department of Housing and Urban Development, 2023). Every
other year, the CoC is also required to count the number of unsheltered people experiencing homelessness
(U.S. Department of Housing and Urban Development, 2023). These counts are locally planned, coordinated,
and conducted (U.S. Department of Housing and Urban Development, 2023). In 2022, the survey estimated
582,462 people were experiencing homelessness in U.S. states and territories with the majority (roughly 60%)
residing in sheltered facilities (U.S. Department of Housing and Urban Development, 2023). Currently, this
survey effort does not collect data on sanitation access for these populations, but it would be quite valuable to
include questions regarding sanitation access since these populations are often not counted by other federal sur-
veys unless they are receiving services at an address surveyed by the U.S. Census Bureau (U.S. Census Bureau,
2020a,2020b,2022c).
The 2020 Decennial Census was designed to counted people receiving services at emergency and transitional
shelters, soup kitchens, and regularly scheduled mobile food vans either with in-person interviews or based on
facility records (U.S. Census Bureau, 2020b), but a study comparing data from PIT, ACS, 2010 Decennial
Census, and Homeless Management Information System (HMIS) databases found that there were many sheltered
residents experiencing homelessness who were classified as housed or in other group quarters for the surveys con-
ducted by the U.S. Census Bureau primarily due to differences between the definition used to classify homeless
shelters in the U.S. Census Bureau surveys and the PIT (Meyer et al., 2023). This study found that 80–95% of resi-
dents in HMIS shelters were counted in the 2010 Decennial Census, but only 35–45% were included in the
sheltered homeless count and the others were counted as in other types of group quarters, housed, or unsheltered
(Meyer et al., 2023). The study also revealed extensive double counting for 21–24% of sheltered populations
experiencing homelessness, 45–56% of those recorded based on meal services, and 29–35% of unsheltered popu-
lations primarily due to residents being included in counts for shelters where they occasionally reside or were
residing for part of the few months in which data is collected (Meyer et al., 2023).
The PIT count and the U.S. Census Bureau depend on the expertise of local groups to identify unsheltered
locations where people are residing (U.S. Census Bureau, 2020b;U.S. Department of Housing and Urban Devel-
opment, 2023), but there are still many difficulties with fully estimating the ‘marginally housed’or residents living
in less public outdoor areas, in automobiles, or temporarily with friends and family especially since these
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populations often fluctuate (Smith & Castañeda-Tinoco, 2019). There is also a limited count of residents experi-
encing homelessness in rural settings due to not all states having ‘Balance of State’(BoS) or statewide CoC
(Yousey & Samudra, 2018).
People experiencing homelessness must rely on shared sanitation facilities with limited upkeep (Frye et al.,
2019) (limited sanitation access) or open defecation (Capone et al., 2018;Amato et al., 2022) which needs to
be included when collecting and evaluating wastewater data for all U.S. residents, but clearly they are not cur-
rently reported as part of the U.S. data to the JMP’s global monitoring of sanitation access data.
OTHER EFFORTS TO COLLECT WASTEWATER DATA IN THE U.S.
OWTS permits (for installation and repair/replacement) are maintained at county and/or state levels with inspec-
tions typically only occurring at installation, replacements, and real estate transactions. A study conducted by the
National Environmental Services Center at West Virginia University compiled OWTS permits from 2015 through
2018 by reaching out to state regulatory agencies and local permitting agencies individually to collect this data
(National Environmental Services Center, 2021). Phase 1 of the study focused on collecting data only from
2015 with an 82% response rate, while Phase 2 only had a 45% response rate when expanding the data to include
2016–2018 (National Environmental Services Center, 2021). While the study has limitations in its reliability for a
nationwide analysis (National Environmental Services Center, 2021), it is currently the only one of its kind. This
study found that the majority of OWTS permits (70%) were administered for new OWTS while 30% were admi-
nistered for repair or replacements of existing OWTS (National Environmental Services Center, 2021). Using data
on new installation permits and new housing development, the study developed an onsite system utilization rate
(OSUR) that estimated 29–32% of new housing units use OWTS (compared to only 23% in 1993) (National
Environmental Services Center, 2021) which indicates that there is an increase in OWTS installation throughout
2015–2018, but the AHS showed a decrease in houses utilizing OWTS between 2015 and 2019 (23.2 million to
20.3 million while the housing stock increased by nearly 6 million housing units) (U.S. Census Bureau, 2015b,
2019). Even with the study’s focus on OWTS permits and not OWTS usage, it provides valuable information
on the changes to OWTS that is more recent than the 1990 Decennial Census and is more reliable than data col-
lected from homeowners.
Other efforts to collect onsite wastewater data in the U.S. have focused on single states or on the usage of
specific methods for wastewater disposal such as straight pipes or cesspools. Efforts to collect straight pipe (sur-
face discharges of raw wastewater) data have documented their presence in 15 states using home-to-home
inspections, agency reporting, resident self-reporting, expert estimate/opinions, and infrared aerial surveying
(Maxcy-Brown et al., 2021). The Minnesota Pollution Control Agency had the most comprehensive state-level
data with estimates for straight pipe usage per county until a transition to reporting imminent threats to public
health and safety together, but the agency is actively providing grants to replace failing OWTS (Helland, 2004;
McCormick & Dowlding, 2020;Maxcy-Brown et al., 2021;Minnesota Pollution Control Agency, 2022). The East-
ern Kentucky PRIDE program actively collected straight pipe data from 40 counties; their last large-scale survey
in 2000 revealed that 6 counties had greater than 15% of homes using straight pipes (The Kentucky Water
Resources Research Institute, 2001;Maxcy-Brown et al., 2021). From 1997 to 2011, the North Carolina Depart-
ment of Environmental and Natural Resources documented data on existing failing OWTS and system repairs in
23 counties (NC-DENR, 2010;Maxcy-Brown et al., 2021). Efforts in Alabama have documented the use of
straight pipes and unpermitted OWTS in three counties; including one county where up to 60% of sampled
houses were using straight pipes and another county where 59% of sampled houses were without a permitted
OWTS (White & Jones, 2006;Elliott et al., 2017). Cesspools are being actively reported and eliminated in
Hawaii (Mezzacapo et al., 2020;State of Hawaii Department of Health, 2021;Coleman, 2022) and New York
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(Smith & Myott, 1975;Hall, 2020; The Island Now, 2021), but have also been documented in Alabama (Flowers,
2020), Mississippi (US Water Alliance and DigDeep, 2019), and Oregon (Rush Locates, n.d.). There are currently
no publicly available state-wide reports for failing outhouses and bucket latrines, but reports for smaller geo-
graphical areas have stated that outhouses are still used in Navajo Nations, Texas Colonias, and Amish
communities (Pressley, 1999;McKenzie, 2002;Associated Press, 2015;US Water Alliance and DigDeep,
2019), and bucket latrines (commonly known as honeybuckets) are used some of the over 3,300 rural homes
in Alaska without piped water and flush toilets (Eddy, 2004;Chambers et al., 2009;Eichelberger et al., 2021;
Mattos et al., 2021a;Alaska Department of Environmental Conservation, 2022). Many of these data collection
techniques have limited scopes because they require site-by-site surveys which can be costly due to their time
and labor-intensive nature.
INTRODUCTION OF WASTEWATER QUESTION TO THE ACS
Through years of efforts by the National Onsite Wastewater Recycling Association (NOWRA) and a proposal sub-
mitted by the EPA, the U.S. Census Bureau has decided to test the inclusion of question H16 (Table 1) from the
long-form Decennial Census in the annual ACS (NOWRA, 2018). The process formally began in 2018, but it is
expected to take at least 5 years to fully test the inclusion before the question will be in the officially distributed
ACS (NOWRA, 2018). It is anticipated to be included in the 2025 ACS Survey (U.S. EPA, 2021c). Therefore, a
more accurate count of U.S. residents who are using septic tank systems should be available in the coming
years, which should better inform policy decisions, manufacturing efforts, and research. Although the question
has limitations, this is an important step toward collecting wastewater data that more accurately represents waste-
water management in the U.S.
CURRENT PERCENTAGE OF U.S. HOUSEHOLDS USING OWTS
As noted throughout this article, there is no recent and reliable estimate of the number of U.S. households with
sewer connections vs. those with OWTS. The 2021 estimate from the Census Bureau (sourced from the AHS) of
15.2% occupied housing units; this estimate is universally regarded as erroneous by the OWTS community
(NOWRA, 2018) and diverse lines of evidence demonstrate that it is implausible. The baseline percentage of
households with OWTS during the 1990 Decennial Census was 24.12%, and this rate is very similar to that
for new homes installed in 1993 and 1998 (23.2 and 24.3%) (National Environmental Services Center, 2021).
Further, a substantial increase in the percentage of new housing units with OWTS has been documented for
2015–2018 (29.1–31.8%). This increase and the addition of roughly 36 million housing units since 1990 is incon-
sistent with the AHS estimate that in 2021 there were about 2.7 million fewer occupied housing units with OWTS
than in 1990 and a 37.1% decrease in the percentage of housing units using OWTS (U.S. Census Bureau, 1993,
2021e,2021g;National Environmental Services Center, 2021). The National Environmental Services Center also
found that a previous U.S. Census Bureau study reported that roughly 3% of residential houses across a 4-year
period were built without a permit (National Environmental Services Center, 2021) which would exclude
homes with OWTS from construction estimations. In addition, the U.S. Census Survey of Construction does
not include mobile (prefabricated) homes, the AHS is more likely to incorrectly mark rural homes as vacant,
and some measurements count clusters of 6 or more homes connected to shared septic systems as connected
to public sewer (NOWRA, 2017;U.S. EPA, 2021c). This shows that OWTS usage rates are being underestimated
across multiple measures. In this section, we propose to generate the first defensible estimate of OWTS usage
since the 1990 Decennial Census.
The estimated national usage of OWTS for 1990–2021 and a contrast with the published AHS data are included
in Table 7 and Supplementary Table S4. It is based on data from the 1990 U.S. Decennial Census (U.S. Census
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Bureau, 1993), the National Environmental Services Center estimate for percentage of new housing units to use
OWTS in 1993, 1998, and 2015–2018 (National Environmental Services Center, 2021), and the AHS estimate of
occupied housing units (U.S. Census Bureau, 2021g). The average of the given values for new housing units with
OWTS in 1993 and 1998 was used to estimate new OWTS for 1991–1997. A simple linear regression was used to
estimate the percentage of new housing units with OWTS for the years 1999–2014 based on the NESC point esti-
mates for the percentage of new housing units with OWTS in 1998 and 2015. The estimate also used the average
percentage of new housing units with OWTS between 2015 and 2018 to estimate new housing units with OWTS
in 2019 and 2021 in order to compare with the most recent AHS data. The estimate calculations found that for
2021, it would be more accurate to estimate 32.2 million housing units use OWTS (25.03% of the U.S. housing
stock), which is approximately 12.7 million more systems than the AHS 2021 estimate.
DISCUSSION AND RECOMMENDATIONS
As publications continue to unveil the lack of equitable access to safely managed wastewater treatment (US Water
Alliance and DigDeep, 2019;Capone et al., 2020;Maxcy-Brown et al., 2021) and the federal government devel-
ops programs to proactively address these wastewater issues (U.S. EPA, 2022a), there should be more systematic
data collection nationwide to identify the housing units and people experiencing homelessness without access to
safely managed sanitation and accurately track progress toward ensuring all wastewater is properly managed in
the U.S. According to the EPA, ‘the existing data sources do not provide the information necessary to accurately
characterize the use of decentralized systems nationally’(U.S. EPA, 2021c) which is a major barrier to addressing
wastewater inequities in the U.S.
Table 7 |Estimated OWTS usage for U.S. households.
Using the 1990 Decennial Census as the baseline (U.S. Census Bureau, 1993), with data from OWTS usage in new housing units (National Environmental
Services Center, 2021) and estimates from the American Housing Survey (U.S. Census Bureau, 2021g), this table provides updated estimates of OWTS usage
through 2021.
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The current data gaps are preventing policymakers and researchers from fully quantifying the costs and benefits
of ensuring all residents have access to safely managed sanitation. The ACS determines how more than $675 bil-
lion of federal spending are allocated each year (U.S. Census Bureau, 2022c), but it currently does not have
mechanisms in place to account for the nationwide wastewater needs that require funding to address. As federally
administered surveys continue to inform the distribution of federal funds, there should be a priority to fund these
surveying efforts and to follow guidelines published by international agencies to collect sufficiently descriptive
data (WHO & UNICEF, 2018;United States Agency for International Development et al., 2021). Even with
the introduction of the wastewater question from the Decennial Census to the ACS, there will be many data
gaps in adequately capturing the wastewater issues currently experienced by residents throughout the country,
especially those experiencing homelessness. Policies should be in place to prioritize the collection of wastewater
data that reflect the current situation for all residents throughout the country without the exclusion of the resi-
dents relying on shared sanitation facilities, open defecation, OWTS, failing wastewater treatment systems, or
no system.
Funding also needs to continue to be allocated to provide systems to the millions of affected Americans. The
accessibility of funding should be improved so even homeowners and communities who currently lack the exper-
tise will be able to apply. This is beginning to be possible through technical assistance funding in the Bipartisan
Infrastructure Law (U.S. EPA, 2022a), but affected residents may need further assistance connecting with grant
writers and engineers who have experience with small systems. All funding mechanisms are currently focused on
the capital costs for installing the wastewater systems, but there also needs to be consideration for the long-term
sustainability of systems that are installed. Many of the systems will serve low-income residents who are unable to
afford the ongoing operation and maintenance expenses which could potentially prevent long-term access to
safely managed sanitation. States should expand the administration of Clean Water State Revolving Funds
(CWSRF) to decentralized projects (U.S. EPA Environmental Financial Advising Board, 2017) to ensure that
all residents are able to access financial assistance for safely managed sanitation, not just ones connected to cen-
tralized sewer systems. In addition, funding should expand to provide resources and support for residents who are
experiencing homelessness and improve their ability to access well-maintained public bathrooms and secure
affordable, long-term housing solutions with safely managed sanitation (Frye et al., 2019;Barker et al., 2023).
The unique sanitation challenges faced by people experiencing homelessness require greater focus and
resources, tailored to both sheltered and unsheltered contexts in urban and rural settings. Although the PIT pro-
vides the best available count of the extent of homelessness in the U.S., it has numerous challenges in generating
data that are accurate, valid, and comparable across local CoC programs (Schneider et al., 2018;Tsai & Alarcón,
2022). Currently, the PIT count methodology is highly variable across the U.S.; while this allows tailoring of
sampling approaches and the survey instrument to the unique characteristics of each local context, it leads to
inconsistencies in data quality and poor comparability across jurisdictions. The PIT could benefit from collabor-
ation across regions to generate a standardized nationwide methodology, while acknowledging that approaches
will need to be tailored to the specific setting (Schneider et al., 2018;Tsai & Alarcón, 2022). The PIT currently
relies on volunteers with limited training, so it is recommended that local and regional CoC programs share strat-
egies for enabling more effective volunteer training and data collection (Schneider et al., 2018;Smith &
Castañeda-Tinoco, 2019;Tsai & Alarcón, 2022). Identified best practices include narrowing the responsibilities
of volunteers to enable more specific and in-depth training, implementing advanced sampling methodologies,
training volunteers to reduce sampling bias, collecting more descriptive data to inform the types of resources
needed, spreading awareness of the counting efforts, providing incentives for participation, and expanding the
network of organizations involved in the count (Schneider et al., 2018;Tsai & Alarcón, 2022). Communities
that have specific initiatives prior to the PIT count for advertising the count are able to establish more accurate
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perceptions and improve the understanding of the PIT count for local residents, volunteers, and individuals
experiencing homelessness (Schneider et al., 2018). These marketing techniques have also resulted in increased
volunteer support, financial resources, and support from influential community members (Schneider et al., 2018).
Community partnerships and support from local governments, community leaders, and private sector have the
potential to improve the resources available for the PIT which can make it more effective (Schneider et al.,
2018). It is also recommended that data collection efforts focus more on identifying and counting marginally
housed populations using strategies such as surveying anyone who may potentially be experiencing homelessness,
implementing ‘respondent-driven sampling’, including day labor worker sites, taking special consideration for
including immigrants and undocumented populations, and ensuring that similar resources are implemented to
document rural homelessness as those resources used for urban homelessness (Yousey & Samudra, 2018;
Smith & Castañeda-Tinoco, 2019;Tsai & Alarcón, 2022). Strategies to avoid double counting such as comparing
respondent data between unsheltered and sheltered counts, comparing Census data with HMIS databases, col-
lecting the last four digits of the respondent’s social security number, recording physical characteristics and
location of the respondents, or collecting other unique identifiers (Smith & Castañeda-Tinoco, 2019;Meyer
et al., 2023). It has also been suggested that the PIT could potentially be replaced by other data sources such
as epidemiological surveys or local ‘by-name lists’that provide just-in-time information and leveraging technol-
ogies to account and track residents experiencing homelessness (Tsai & Alarcón, 2022). Having improved
data on residents experiencing homelessness will not only improve understanding the scope of their sanitation
challenges, but it will also enable organizations to have better data for their efforts to serve these residents and
apply for financial assistance (Smith & Castañeda-Tinoco, 2019).
The current Administration has put forth many efforts to ensure that resources are made available to address
environmental justice issues throughout the country and ensure that all residents have equitable access to healthy
environments. These efforts for wastewater equity include the addition of specific language in legislation author-
ized funds specifically to disadvantaged communities (U.S. EPA, 2022a), the authorization of $100 million for
environmental justice grants (U.S. EPA, 2023a), the development of the EJScreen: Environmental Justice Screen-
ing and Mapping Tool (U.S. EPA, 2023b), the launching of Closing America’s Wastewater Access Gap
Community Initiative (U.S. EPA, 2022b), Justice40 (Young et al., 2021; The White House, 2022), and more.
These efforts could be more efficiently expanded with accurate, comprehensive wastewater access data to
target areas where solutions need to be mobilized.
To complement the efforts of the federal government, state and local governments should take specific actions
to determine impacted communities and authorize resources (funding, personnel, supplies, etc.) to communities
with historic, ongoing environmental justice issues to ensure that all residents are protected from wastewater
access challenges. These policies should include financial assistance to utility customer assistance programs
and to residents with unaffordable OWTS. Funding should also be allocated to programs that support low-cost
installations of low-flow plumbing fixtures, protect against water shut-offs, increase accessibility to resources,
and other programs that directly improve local wastewater issues.
It is essential to have accurate and comprehensive data on wastewater access to determine which residents are
experiencing issues and what policies would be effective to address these issues for protecting the human right to
safely manage wastewater treatment for all residents in the U.S.
CONCLUSIONS
To accurately track progress toward equitable sanitation access for all, improvements to the mechanisms used to
collect wastewater access data in the U.S. are needed. It is concerning to see an under-prioritization of data on a
key human right that is not only essential for protecting human health but also the environment. The AHS has
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been relying on a limited sample set that under-samples in rural areas and has yielded a gross underestimation in
the usage of OWTS. Despite being the only current nationwide source of wastewater data, the AHS estimates con-
tradict related data and have been viewed as insufficient by the OWTS industry and the EPA (NOWRA, 2018;
National Environmental Services Center, 2021;U.S. EPA, 2021c).
The U.S. is making a key step toward collecting more accurate wastewater access data by introducing the ques-
tion on sewage disposal from the Decennial Census to the ACS, but there will still be gaps in understanding and
interpreting the affordability, reliability, and functionality of residents’wastewater management. Most nationwide
surveys are overlooking the populations experiencing homelessness, which excludes almost 600,000 residents
from national data sets. Policies should be implemented to ensure equitable and accurate representation of waste-
water access for all residents. There should be requirements to implement the use of these data to inform funding
allocations that protect the human right to affordable, reliable sanitation for every resident in the U.S.
DATA AVAILABILITY STATEMENT
All relevant data are included in the paper or its Supplementary Information.
CONFLICT OF INTEREST
The authors declare there is no conflict.
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