Proper wastewater treatment in urban and rural areas is crucial for human and environmental health. Many rural and unincorporated areas utilize decentralized wastewater treatment systems for homes and businesses, including individual aerobic treatment units (ATUs) or septic tanks. Residential ATUs are designed to process about 500 gallons of domestic wastewater per day and can serve a household with ease. Microbial bacteria in an ATU break down solid organic waste and decrease pathogens and pollutants in wastewater, discharging effluent that drains into ditches and nearby waterbodies. These systems can pose a significant human health and ecosystem hazard when not properly functioning. Pontchartrain Conservancy (PC) has conducted thousands of surveys across several coastal parishes, including St. Tammany, Plaquemines, and Tangipahoa, to determine the efficacy of residential ATUs and their impact on local waterbodies. These surveys included a visual assessment of the on-site sewage system, technical assistance, and resident education. Results showed a 50-65% system failure rate and a lack of resident knowledge and experience repairing home sewage systems. Most ATU failures result from non-functioning aerators, which kill the microbial bacteria and allow solids to build in the tank. System failures lead to the release of untreated sewage into ditches and degrade the environment, killing aquatic life, boosting mosquito production, and polluting nearby waterbodies. Additionally, failures cause high nutrient loading and low dissolved oxygen, putting many of Louisiana’s waterbodies on the EPA’s Impaired Waterbodies list. PC’s home inspection program illustrates a state-wide problem with decentralized sewage systems. Furthermore, this work highlights the need for increased inspection, regulation, and education for on-site sewage systems. Increasing the efficacy of decentralized wastewater systems is vital for public health and clean water, particularly in the coastal and river parishes most vulnerable to the mounting risks from tropical cyclones.