raditionally, the operation and maintenance of onsite systems was left to homeowners resulting in many cases in system failure due to improper maintenance. Since onsite septic systems were considered as temporary solutions awaiting centralized treatment and collection, many systems currently in use do not provide a treatment level that is needed to protect public health and the receiving environment. Hence, it is essential to develop policies, programs, guidelines, and institutions to ensure the proper design, construction as well as operation and maintenance of decentralized wastewater treatment systems. With rapidly increasing population and decreasing water resources, wastewater is becoming a significant resource. Accordingly, there is a substantial need for more integrated management of both onsite and cluster wastewater treatment systems. An integrated management approach ensures that all the perspectives of effective management that include economical, social, technical and environmental dimensions are taken into consideration. It is important to note that the needs and conditions of wastewater management vary from country to country and sometimes within the same country. Properly managing a system helps in protecting public health and local water sources, increasing the property value and avoiding expensive repairs. Such management systems should address the major problems related to wastewater treatment approaches primarily in developing countries. These include but are not limited to: