In 1987, a small sewage treatment facilities survey was conducted of all county and local health departments in Ohio. The objectives were to learn how local sewage treatment facilities programs are managed, the types of systems in use, the numbers of permits issued, and the number of systems that are failing. The survey results indicate that urban areas in Ohio have the largest health departments and had over 13,000 permits issued in 1986 which accounted for the greatest number of permits. Site evaluation procedures varied greatly across the state. In 25 counties, permits were issued without a visit to the site. Sanitarians estimated that 27% of the septic systems are failing. Aerobic systems are used heavily in Ohio, while alternative systems have limited use. To address the problems of failing systems and unsuitable sites for septic systems, more information is needed at the county level about alternative sewage systems and on-site system management.