On-site wastewater treatment systems (OWTS) are essential parts of wastewater treatment infrastructure throughout the world. In the United States, OWTS serve between 20% and 25% of homes in the country. Though access to septage treatment appears to be a ubiquitous problem in the United States, this issue has received relatively little attention. Here, we examined county-level estimates of the number of OWTS and treatment options in the state of Georgia in the United States. We also used municipal and regional data collected from wastewater treatment facilities to highlight relationships among treatment options for septage disposal, the cost of septage treatment, and the amount of septage delivered to receiving plants. We conservatively estimate the state should generate at least 932000 gallons per day (GPD) but has the capacity to treat only 500000–650000 GPD. More than 70% of counties in the state do not support municipal treatment options for septage. The data we report at the municipal and regional levels highlight negative relationships between the amount of septage delivered to treatment facilities and the price of treatment. Local and state agencies must develop policies and generate the funding needed to manage the entire life cycle of wastewater generated within their jurisdictional boundaries.