Onsite sewage disposal systems (OSDSs) are the third leading cause of groundwater contamination in the USA. The existing condition of OSDSs in the State of Hawaii was investigated to determine whether a mandatory management program should be implemented. Based on observed conditions, OSDSs were differentiated into four categories: ‘pass’, ‘sludge scum’, ‘potential failure’ and ‘fail’. Of all OSDSs inspected, approximately 68% appear to be in good working condition while the remaining 32% are failing or are in danger of failing. Homeowner interviews found that 80% of OSDSs were not being serviced in any way. About 70% of effluent samples had values of total-N and total-P greater than typical values and 40% had total suspended solids (TSS) and 5-day biochemical oxygen demand (BOD5) greater than typical values. The performance of aerobic treatment units (ATUs) was no better than septic tanks and cesspools indicating that the State's approach of requiring but not enforcing maintenance contracts for ATUs is not working. In addition, effluent samples from OSDSs located in drinking water wells estimated 2-year capture zones had higher average concentrations of TSS, BOD5, and total-P than units outside of these zones, indicating the potential for contamination. These findings suggest the need to introduce a proactive, life-cycle OSDS management program in the State of Hawaii.