Making waves: Right in our backyard- surface discharge of untreated wastewater from homes in the United States.

Roughly ¼ of U.S. residents (80 million people) lack access to sanitary sewers and are required to treat their wastewater through a permitted onsite wastewater treatment system (OWTS). The vast majority use conventional septic systems with subsurface infiltration, which work well under most conditions. However, certain geologic conditions (e.g., impermeable soil, high water table) can preclude use of septic systems, requiring investment in expensive advanced OWTS. The confluence of lack of sewer, unsuitable geology, and poverty can lead households to have no feasible option for treating wastewater. In many such communities households discharge raw sewage onto the ground through what are commonly called "straight pipes." Here, we present the first effort to synthesize available evidence documenting the scope of straight pipe use in the U.S., including estimates of close to 50% straight pipe use in some counties. Despite reports that straight pipes are widespread and troubling preliminary evidence of adverse health effects, there has been no national effort to estimate the use or impacts of straight pipes. There are various disincentives that discourage the reporting of straight pipes by both residents and government actors. We propose ways to improve quantification of straight pipes and increase knowledge of their adverse effects. We identify the characteristics of areas with large proportions of straight pipes and describe the role of new and pending government programs in encouraging reporting and providing solutions.