The Town of Nags Head is a popular coastal community located along the Outer Banks in North Carolina. Tetra Tech assisted the Town in updating the Decentralized Wastewater Management Plan (DWMP) and Todd D. Krafft Septic Health Initiative (SHI). The Updated DWMP and SHI were refined to serve as wastewater treatment guides to the Town for effective and proactive decision-making for onsite wastewater treatment systems (OWTS). Specifically, the DWMP Update included new sections addressing climate change, Sea Level Rise, Vulnerability, Risk, and detailed Groundwater data. The SHI provides a unique mechanism (and model for other coastal communities) that provides assistance to homeowners to effectively maintain their private septic systems through free septic system inspections, rebates to water utility bills for septic system pump outs, low-interest loans for septic system repairs, education, and surface water quality/bacteria testing. As part of the update process, Tetra Tech reviewed surface water quality and bacteria data which was collected by the Town of Nags Head since 2005 to determine if any pollutant “hot spots” or indicators of septic system failures were present in groundwater and surface water. In addition, Tetra Tech partnered with East Carolina University Coastal Studies Institute (ECU CSI) to obtain 12 months of groundwater table elevation data at eight regional groundwater wells and five OWTS sample wells located in Nags Head. The data was then used to correlate groundwater table elevation in relation to mean sea elevation, the potential for OWTS failure, and future risk of groundwater contamination.