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Prospects and Challenges for Sustainable Sanitation in Developed Nations: A

Critical Review

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DOI: 10.1139/er-2013-0082

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1

REVIEW
Prospects and challenges for sustainable sanitation in
developed nations: a critical review
Edwin Brands
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14

Abstract: Serious sanitation challenges are not confined to developing nations. Infrastructure costs, nutrient losses and related
ubiquitous surface water impairments, energy demands, and sludge disposal problems have led many to question the long-term
sustainability of conventional centralized sanitation in developed nations. Such concerns have resulted in the development of
a body of literature and practices aimed at making sanitation more sustainable. This paper has two major aims: (i) provide a
representative multidisciplinary (including engineering, natural sciences, and social sciences) synthesis of literature on sustain-
able sanitation in developed nations over the past 15 years, and (ii) raise consciousness of sustainable sanitation approaches in
regions and disciplines where this area of inquiry has at least partly been neglected. Literature included in the review was
identified by searching the ISI Web of Knowledge and by “mining” key review papers that already synthesized literature on
topics such as ecological sanitation, excreta as fertilizer, and wastewater reuse. The sustainability challenges faced by conven-
tional sanitation are discussed first, followed by a review of efforts in two major areas of sustainable sanitation: (i) incremental
improvements to conventional centralized sanitation, and (ii) source separation and decentralization (SSD). Based on the
literature review, there does not appear to be a perfect solution to the sanitation challenges (e.g., water use and pollution,
greenhouse gas emissions, nutrient and micropollutant releases) faced by society. Compared with SSD, there is a much broader
knowledge base on the construction, operation, and maintenance of conventional sanitation systems. And there are significant
opportunities for incremental improvements (e.g., reduction of water, energy use), but also significant drawbacks such as the
costs of maintaining ageing infrastructure and the mixing of domestic, storm, and industrial effluents. On the other hand, SSD
For personal use only.

is conceptually promising, and significant progress has been made over the last two decades in basic research and in exploring
various SSD models. But SSD is still in its relative infancy: literature and pilot projects are regionally limited and significant
logistical, behavioral, regulatory, and other challenges remain. Contributions that meaningfully address sanitation “software”
or social perspectives are, therefore, urgently needed from social science fields including economics, policy, and behavioral
psychology. Progress toward achieving sustainable sanitation can be aided by addressing four major areas: (i) defining sustain-
ability goals and benchmarks, (ii) raising societal awareness of sanitation problems, (iii) broadening the societal and geographical
scope of the research, and (iv) more thoroughly exploring barriers to adapting or changing sanitation systems.

Key words: sanitation, source separation, developed nations, sustainability.

Résumé : Les problèmes sanitaires graves ne sont pas confinés aux pays en développement. Les coûts en infrastructures, les
pertes de nutriments et les dégradations des eaux de surface ubiquistes qui leurs sont reliées, ainsi que les demandes en énergie
et les problèmes d’élimination des boues résiduelles, en ont conduit plus d’un à s’interroger sur la durabilité à long terme des
traitements sanitaires centralisés dans les pays développés. De telles préoccupations ont engendré une abondante littérature des
pratiques visant à rendre l’assainissement plus durable. Cette revue vise deux objectifs principaux : (i) présenter une synthèse
multidisciplinaire de la littérature (incluant l’ingénierie, les sciences naturelles et les sciences sociales) sur l’assainissement
durable dans les pays développés au cours des 15 dernières années, et (ii) une sensibilisation aux approches d’assainissement
durable dans les régions et les disciplines où ce champ de recherche a été au moins partiellement négligé. L’auteur a identifié la
littérature citée en parcourant le ISI Web of Knowledge et en suivant la piste de revues ayant déjà synthétisé la littérature sur des
sujets tels que l’assainissement écologique, les excréments et les fertilisants ainsi que la recyclage de l’eau. On discute d’abord
les défis à la durabilité posés par l’assainissement conventionnel, avant de revoir les efforts dans deux secteurs majeurs de
l’assainissement sanitaire : (i) améliorations progressives à l’assainissement centralisé conventionnel, et (ii) séparation à la
source et décentralisation (SSD). Sur la base de cette revue de la littérature, il ne semble pas y avoir de solution parfaite aux défis
de l’assainissement (p. ex. l’utilisation de l’eau et la pollution, l’émission de gaz à effets de serre, le relâchement de nutriments
et de micropolluants). Comparativement à la SSD, on retrouve une base de connaissances beaucoup plus étendue sur la
construction, la gestion et l’entretien des systèmes d’assainissement conventionnels. Mais il y a d’importantes opportunités
d’améliorations progressives (p. ex. réduction de l’utilisation de l’eau et de l’énergie), mais également des désavantages comme
les coûts pour maintenir des infrastructures âgées et le mélange des effluents domestiques, des égouts de surface ainsi
qu’industriels. D’autre part, la SSD est conceptuellement prometteuse et des progrès significatifs ont été réalisés au cours des
deux dernières décennies en terme de recherche de base et d’exploration de divers modèles de SSD. Mais la SSD n’en est qu’à ses
tout débuts : la littérature et les projets pilotes sont régionalement limités et il reste beaucoup à faire en terme de logistique, de
comportement et autres défis à relever. Il y a donc un urgent besoin pour des contributions visant de façon significative les
“logiciels” ou perspectives sociales, provenant des champs des sciences sociales incluant l’économie, la réglementation et la

Received 17 December 2013. Accepted 4 April 2014.

E. Brands. Environmental Studies Program, University of Minnesota Morris, 600 East 4th Street, Morris, MN 56267, USA.
E-mail for correspondence: ebrands@umn.edu.

Environ. Rev. 22: 1–18 (2014) dx.doi.org/10.1139/er-2013-0082 Published at www.nrcresearchpress.com/er on 7 April 2014.
 Pagination not final (cite DOI) / Pagination provisoire (citer le DOI)
2 Environ. Rev. Vol. 22, 2014
psychologie du comportement. On pourra assurer le progrès vers l’assainissement durable en s’adressant à quatre champs
majeurs : (i) définir les objectifs et les références, (ii) soulever la conscience sociale au sujet de l’assainissement, (iii) élargir la
portée de la recherche sociétale et géographique, et (iv) en explorer plus à fond les barrières à l’adaptation ou aux changements
des systèmes d’assainissement. [Traduit par la Rédaction]
Mots-clés : assainissement, séparation à la source, pays développés, durabilité.
1. Introduction
Sanitation and sustainable sanitation
To address contemporary sanitation dilemmas, we must con-
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
sider the involved technologies and institutions; linkages to food,
nutrient, water, and carbon cycles; environmental impacts; social
and cultural dimensions; questions of governance; and the roles
of myriad stakeholders in the process of sanitation (van Vliet et al.
2011). Common definitions (see, for example, the Oxford English
Dictionary, Webster’s 3rd New International Dictionary, or Collins
American English Dictionary) refer to sanitation as the process of
promoting human health by keeping places clean and hygienic,
particularly by providing a wastewater treatment system and
clean water supply. They leave out the regulation and financing of
such systems, the interactions between various sanitation stake-
holders, and the fact that valuable resources are contained in
excreta. Source separation and decentralization (SSD) is a rela-
tively new sanitation paradigm that offers more efficient recovery
of valuable resources from human excreta without copious use of
water. In part because both SSD and wastewater reclamation pro-
grams require at least the perception of more interaction with our
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excreta, recent work in these areas underscores the importance of
social science perspectives and multidisciplinary cooperation in
order for continued progress to be made in the area of sustainable
sanitation.
Sustainable sanitation can be defined as a means of cycling
human excrement that has no net negative impact — or even a
positive impact — on local and global resources. Can sustainable
sanitation be achieved via incremental improvements upon con-
ventional sanitation? Or is it only possible via a paradigm shift?
Varis and Somlyódy (1997) note that, if implemented perfectly,
conventional urban sanitation could be sustainable. This would
require high-skilled labor, steady capital investments within a stable
socio-economic situation, closed material cycles, self-sufficient en-
ergy production, and no harmful releases to the environment. On
the other hand, Butler and Parkinson (1997) argue that wastewater
treatment cannot be sustainable because it is a stopgap measure
for dealing with overconsumption. Similarly, Bracken et al. (2006)
contend that the modern wastewater treatment plant (WWTP)
and accompanying infrastructure, like the Roman Cloaca Max-
ima, is an emergency solution.
Chen and Beck (1997) distinguish between strong sustainability,
which allows for no deterioration of the natural environment,
and weak sustainability, which “…allows an inferior quality of the
natural environment to be passed on, provided this loss is offset
by an increase in other stock, such as roads, infrastructure…”
(p. 100). They assert that weak sustainability is not an appropriate
guide for freshwater resource management. Judging whether a
particular approach to sanitation is sustainable (strong or weak)
requires the establishment of sustainability benchmarks, which
to some degree may be context dependent but should be linked to
the major sustainability challenges identified below.
Whereas sanitation issues in many developing nations are fo-
cused on providing access to some form of improved sanitation,
major concerns with sanitation in highly urbanized developed
nations center on the impacts of conventional centralized sanita-
tion, which is the most prevalent approach in these nations. Wa-
ter and energy use; releases of reactive nitrogen, phosphorus,
pharmaceuticals, and other micropollutants; and greenhouse gas
emissions link conventional centralized sanitation to many of the
daunting sustainability challenges of our time (Boyle et al. 2010;
Guest et al. 2009; Rockström et al. 2009; Galloway et al. 2008;
Childers et al. 2011; Schwarzenbach et al. 2010; Focazio et al. 2008).
There are increasing efforts to bring sanitation into an inte-
grated urban water management (IUWM) framework to increase
communication and cooperation among often separately man-
aged drinking water, wastewater, and storm water systems and
reconnect with the absorptive capacities of local and regional
environments (Mitchell 2006; Burn et al. 2012). IUWM and other
holistic approaches to water management were at least in part
inspired by the seminal work of Wolman (1965) on re-examining
the city as an organism with metabolic flows of materials, water,
energy, and nutrients. But despite these efforts, conventional san-
itation has often been operated as if it is simply a part of the urban
drainage system — a way to get rid of unneeded or unwanted
wastes (van Vliet 1996; Butler and Davies 2011; Beck 2013).
This paper has three major aims: (i) provide a representative
multidisciplinary (including engineering, natural sciences, and
social sciences) synthesis of literature on sustainable sanitation in
developed nations over the past 15 years, (ii) evaluate progress and
challenges for achieving sustainable sanitation in developed na-
tions, and (iii) raise consciousness of sustainable sanitation ap-
proaches in regions and disciplines where this area of inquiry has
at least partly been neglected. First, the process of conventional
sanitation is reviewed, and challenges for the long-term sustain-
ability of conventional sanitation are discussed. Then the two
major thrusts to achieve sustainable sanitation are addressed:
(i) incremental improvements to conventional sanitation, or waste-
water treatment as renewable resource recovery, and (ii) the adop-
tion of a new sanitation paradigm of SSD. Following a section
emphasizing the importance of social science contributions to
sustainable sanitation efforts, the paper concludes with a discus-
sion of four major areas for future work to help maintain momen-
tum for sustainable sanitation: (i) defining sustainability goals and
benchmarks, (ii) raising societal awareness of sanitation prob-
lems, (iii) broadening the societal and geographical scope of re-
search, and (iv) more thoroughly exploring barriers to adapting or
changing sanitation systems.
2. Methods
Most of the articles and book chapters selected for inclusion
were identified through two major strategies: (i) by searching the
Thomson Reuters Web of Science Core Collection, and (ii) by “min-
ing” key review papers that already synthesized literature on topics
such as ecological sanitation, excreta as fertilizer, and wastewater
reuse. Several sets of keywords such as sustainable + sanitation
and human + urine + fertilizer were used in the search process
(additional search terms included energy recovery + wastewater,
wastewater + micropollutants, economics + sanitation, wastewa-
ter + reuse, and many others; several of the initial search terms
can be found in the section headings below). This initial set of
results was then narrowed by selecting only those articles that
were relevant to human sanitation, written by authors from de-
veloped nations, and focused on developed country contexts
(some minor exceptions were made to the developed country fo-
cus; for example, because okra is commonly cultivated in some
developed nations, work done on urine-fertilized okra cultivation
in Nigeria was included). Table 1 illustrates the selection process
for the keywords human + urine + fertilizer. After this initial
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Brands
Table 1. Selection process for articles using Thomson Reuters Web of
Science.
Database
Web of
Science core
Selection criteria collection SCI-EXP SSCI
Keywords: human + urine + fertilizer 89 87
Relevant to human sanitation 73 71
Developed nation in country/territory field 50 49
Study done in developed nation context 46 45
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
Note: SCI-EXP, Science Citation Index-Expanded; SSCI, Social Sciences Cita-
tion Index.
selection process, the list of identified articles was further nar-
rowed, as even after the selection process there were articles that
were not immediately relevant to the paper’s focus, or whose
inclusion would result in unnecessary redundancy.
The second step in literature selection consisted of adding rel-
evant articles from the citations of those reviewed in step 1. Once
these articles were located and summarized, a general outline was
constructed based on the clustering of articles into two general
categories (source separation vs. incremental changes to conven-
tional sanitation), and then into subcategories (e.g., water recovery,
energy recovery, economics) within the two general categories. In
the process of writing the individual paper sections, it was occa-
sionally necessary to locate, consult, and include additional refer-
ences to provide context or to provide important details such as
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the composition of wastewater or the proportion of nutrients
that could be recovered using various wastewater treatment
methods. Finally, Source Separation and Decentralization for Wastewater
Management (edited by Larsen et al. 2013) was published and be-
came available during the writing of this paper, and several chap-
ters from this comprehensive volume are cited throughout. The
overarching goal of the paper was to produce a representative
rather than comprehensive review of the sustainable sanitation
literature. It is acknowledged that the search process discussed
above likely provides only a broad overview of the sustainable
sanitation knowledge developed in the past 15 years.
To investigate assertions by authors of several papers (e.g., Van
Vliet et al. 2011) that the sanitation literature is dominated by
natural sciences and engineering disciplines, the process de-
scribed in step 1 above was conducted separately on the Social
Sciences Citation Index (SSCI) and the Science Citation Index-
Expanded (SCI-EXP). A brief analysis of results of two keyword
searches appears to support the idea that social sciences are rela-
tively underrepresented when it comes to sanitation and sustain-
able sanitation. A search for the keywords sustainable + sanitation
in SCI-EXP (2002–2013) yielded 283 results, whereas an identical
search in the SSCI yielded 102 results. A more extreme case is
illustrated by the results of searching the keywords human +
urine + fertilizer, in which the SCI-EXP search yielded 87 results,
and the SSCI search yielded only three (Table 1).
3. Conventional sanitation
Conventional sanitation is typically described beginning at the
point of excretion or discharge of wastes into the sewer pipes and
ending with the discharge of effluent from WWTPs. However,
sanitation is linked to many processes upstream from the toilet
and downstream from the treatment plant outfall (Fig. 1, Werner
et al. 2009). In other words, the quality of the influent wastewater
is intimately linked to the substances we consume (e.g., food,
detergents, pharmaceuticals, personal care products) and those
substances produced and consumed as part of our industrial soci-
ety (e.g., metals, acids, solvents, organic pollutants). Figure 1 de-
picts a system in which stormwater and sewage are separated, but
many wastewater systems in the United States and Europe are
3
combined or partially combined and susceptible to overflows dur-
ing precipitation events. Conventional sanitation sends a signifi-
cant proportion of nutrients downstream into the atmosphere or
into landfills, with only a small proportion recycled back to
agriculture. Nutrients must then be replaced by external inputs.
Because there are direct links between treatment plant and storm-
water effluents and surface waters, aquatic organisms and hu-
3 mans in downstream cities are also at risk of exposure to trace
3 amounts of pharmaceuticals and personal care products from up-
2 stream cities’ effluent (Ternes et al. 2004; Werner et al. 2009).
1
3.1. Wastewater
Wastewater (or sewage) is a combination of domestic (Table 2),
commercial, and industrial effluents and often inflow/infiltration.
It can generally be described as a large volume of water containing
low concentrations of nitrogen and phosphorus and organic mat-
ter (chemical and biological oxygen demand), and trace concen-
trations of numerous industrial, household, and other trace or
micropollutants (Butler and Davies 2011). Domestic wastewater
itself is a combination of greywater (shower, bath, sink) and ex-
creta (feces and urine), and contributes mainly nontoxic wastes
(organic matter, nutrients, pathogens), whereas industry is the
most common source of toxic substances (e.g., metals, volatile
organic compounds) in wastewater (Bitton 2011). In conventional
sanitation, wastewater is most commonly treated at one central-
ized plant, a series of distributed centralized plants (e.g., New
York City), or a combination of upstream water reclamation
plants and downstream solids processing plants (e.g., Los Angeles)
(Tchobanoglous and Leverenz 2013). It should be noted that waste-
water flow rates and contaminant concentrations are not con-
stant and exhibit significant diurnal fluctuations (such as during
morning showers and toilet flushes) and other temporal varia-
tions that must be taken into account in system design and ad-
justments at the treatment plant (Butler and Davies 2011).
3.2. Wastewater treatment
Wastewater systems (Fig. 2) begin with sewer connections be-
tween households, industry, and institutions and sewer main
pipes, although industrial plants often have their own treatment
or pretreatment processes. As it enters the treatment plant, waste-
water is initially run through a screen with 1 cm or smaller open-
ings to remove large floating debris. As the flow of the stream is
slowed, a series of holding chambers allow successively smaller
sinkable solids to settle, at which point they are removed from the
process as grit and primary sludge. Biological treatment is the
most common method of reducing organic matter concentrations
in wastewater (secondary treatment). Aerobic activated sludge
systems are the most common and consist of aerated basins in
which aerobic bacteria and other microorganisms are suspended
and encouraged to grow, binding up the majority of the organic
matter in biomass (new microorganisms). Next, wastewater flows
into the secondary clarifier where microorganism-rich activated
sludge settles to the bottom and is partially recycled back into the
aeration tanks. Phosphorus may be removed during primary
treatment via chemical precipitation or during secondary treat-
ment via biological precipitation; in either case, unless a separate
phosphorus removal process is implemented, precipitated phos-
phorus ends up in sludge. Nitrogen is most often removed biolog-
ically via nitrification (ammonia¡nitrate) and denitrification
(nitrate¡nitrogen gas released to atmosphere). In some cases,
advanced treatment (e.g., reverse osmosis, distillation, electrodi-
alysis, ion exchange, ultra filtration) is necessary to remove dis-
solved inorganic, organic contaminants, or pathogens remaining
in secondary effluent. In some European nations, 4th step treat-
ment is being considered for the purpose of targeting micropollut-
ants such as pharmaceuticals. Disinfection (to eliminate remaining
microorganisms prior to discharge) via chlorine, ozone, ultravio-
let radiation, or other methods is often the final treatment step.
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4 Environ. Rev. Vol. 22, 2014

Fig. 1. Conceptual diagram of conventional sanitation. Arrows are nonquantitative representations of resource (water, nutrients, organic
matter) flows associated with conventional sanitation and connected processes. Adapted from Werner et al. (2009), with permission from
Elsevier.
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For personal use only.

Table 2. Typical major components of untreated domestic wastewater. pipe connecting private buildings and industries to the public
Concentration (mg/L) sewers (US EPA 2010a).
Despite recent innovations in pipe repair technologies, there is
Contaminants High Medium Low a growing backlog of necessary repairs to existing systems. The US
Biological oxygen demand (BOD) 350 190 110 EPA (2008) estimated capital investment needs at nearly $300 bil-
Chemical oxygen demand (COD) 800 430 250 lion over the next two decades for wastewater and stormwater
Organic nitrogen 25 15 8 infrastructure. Many older cities in the United States and Europe
Ammonia-nitrogen 45 25 12 have combined sewer systems that carry both wastewater and
Total nitrogen 70 40 20 stormwater, resulting in thousands of combined sewer overflows
Total phosphorus 12 7 4 annually — over 900 permitted combined sewer overflows out-
Total solids 1230 720 390 falls still exist in New York State alone (NYDEC 2013). The total
Suspended solids 400 210 120 value of wastewater infrastructure is difficult to estimate because
Chlorides 90 50 30 of continual updates, repairs, and expansions and because bene-
Sulfate 50 30 20 fits to and impacts on receiving waters, air, and land are difficult
Oil and grease 100 90 50 to quantify (Maurer 2013; Guest et al. 2009).
Volatile organic compounds (VOCs) >400 100–400 <100
Total coliform (No./100 mL) 107–1010 107–109 106–108 4. Sustainability challenges for conventional
Cryptosporidium oocysts (No./100 mL) 10−1–102 10−1–101 10−1–100
sanitation
Note: From Tchobanouglous et al. (2003), Table 3-15 with permission from
McGraw Hill Inc. 4.1. Conflicting objectives
Conflict among changing objectives is one of the overarching
sustainability challenges for conventional sanitation. The first ob-
Additional processes (such as infiltration, land application, and jective is protecting and maintaining (human) community health;
filtering via constructed wetlands) may help polish wastewater a second objective, environmental protection, came somewhat
before it is discharged into surface waters (Tchobanoglous et al. later (1960s and after); and a third objective, resource recovery and
2003; US EPA 2004a). sustainability, is the most recent (Butler and Parkinson 1997;
Delleur 2003). The first objective has, in large part, been met by
3.3. Wastewater infrastructure conventional sanitation. However, if human excreta continue to
About 16 000 wastewater treatment systems serve approxi- be viewed as “…worthless waste to be disposed of…” and the
mately 70% of the US population, with the remainder served by design of wastewater treatment infrastructure continues to re-
decentralized systems such as septic tanks (US EPA 2010a; flect this view, achieving the second and especially the third ob-
Tchobanoglous and Leverenz 2013). In Europe, the proportion of jective will be daunting (Bracken et al. 2006, p. 225). A significant
the population connected to wastewater treatment facilities shift will be necessary to overcome this “urine blindness” and
ranges from 7% (Macedonia) to 99% (UK), with the majority of fully embrace the ecological sanitation era (Drangert 1998; Ashley
nations between 50% and 80% connected (Eurostat 2011). In the et al. 2011).
United States alone, there are over 740 000 miles of pipes and Most historical human settlements and even modern urban
more than 12 million manhole fixtures associated with public areas in developed nations (e.g., Paris until the early 20th century)
wastewater systems, and another 500 000 miles of lateral sewer recycled a significant proportion of human excreta and derived

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Brands
Fig. 2. Typical aerobic wastewater treatment system, representative of many wastewater treatment plants (WWTPs) found in Europe and the
United States, although many other configurations exist. Adapted from Tchobanoglous et al. (2003), with permission from McGraw Hill Inc.
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
nutrients and organic matter back into agricultural systems
(Ashley et al. 2011; Barles 2007). However, excreta disposal and
recycling methods (e.g., night soil collection) of this period did not
prevent pollution of local waters or propagation of devastating
waterborne diseases. The installation of sewers and centralized
WWTPs was a major driving force in reducing mortality in and
increasing the general viability of urban areas (Melosi 2008). For
example, Ferrie and Troesken (2008) attribute up to half of the
60% reduction in mortality in Chicago between 1850 and 1925 to
water purification efforts. On the other hand, waterborne sewer-
age contributed to many problems (such as eutrophication of re-
ceiving waters and copious use of water) and effectively ended
cycling of organic matter and nutrients back to agriculture.
The history of phosphorus reuse in Linköping, Sweden (Table 3),
For personal use only.
illustrates the shift in emphasis from recycling nutrients (1870
and 1900) to protecting public health via waterborne sewerage
(1950) to protecting public health and water quality (1975 and
2000). Phosphorus reuse declined precipitously from 85% in 1870
to only 5% in 1950 with flush toilet implementation. Reuse of
phosphorus slowly recovered to approximately 20% in 2000 after
construction of a sewage treatment plant in the 1960s allowed for
capture of the majority of phosphorus from wastewater. The late
1980s sludge boycott by farmers, however, largely thwarted ef-
forts to reuse the majority of phosphorus contained in sewage
sludge (Neset et al. 2010).
4.2. The weight of wastewater
Xu et al. (2010) classify sanitation as one of several interrelated
urban infrastructure gigaton problems (along with climate
change, energy and water shortages, water contamination, and
food security) in need of significant attention. Compared with
other urban waste streams, wastewater is by far the largest by
weight: four studies of major cities in the 1990s all found that
wastewater comprised 90% or more of total urban wastes (Table 4).
Developed nations generate a population weighted average of 185
L/capita/day of wastewater (Friedler et al. 2013; US Census Bureau
2013). In the United States, 120 billion L/day of treated municipal
wastewater (TMWW) are discharged, 45 billion L of which are
discharged into oceans or estuaries (National Research Council
2012).
4.3. Sewage sludge and biosolids
All conventional WWTPs produce sludge and must find some
means of reuse or disposal. Dumping of sludge into oceans was
phased out by the early 1990s in the United States (via the Marine
Protection Research and Sanctuaries Act of 1972 and subsequent
amendments) and in Europe via involvement in the Helsinki Con-
vention and other international agreements (Copeland 2010). In
the United States, digested sewage sludge, or biosolids, is catego-
rized either as Class A (no detectable pathogens) or Class B
(treated, but detectable pathogens remain). Only Class A biosolids
may be used as fertilizer in lawns or gardens (Tchobanoglous et al.
2003).
5
The precise composition of sludge or biosolids is rarely known,
and human health risks associated with land application of bio-
solids are believed to be low. However, health impacts of biosolids
application have been reported. In one study, up to 25% of people
living near sites where Class B biosolids were spread had serious
Staphylococcus aureus infections, which contributed to the deaths of
two of the 48 individuals in the study (Lewis and Gattie 2002). The
US National Research Council (2002) recommended establish-
ment of a tracking system for health effects of exposure to land
applied biosolids, but such a mechanism appears not to have been
developed.
In Europe the proportion of sludge or digested sludge diverted
to agriculture varies from zero (Slovakia, Slovenia, the Nether-
lands) to 75% (Cyprus) and nearly 100% (Bulgaria, Iceland, Malta)
with the majority of European nations applying between 10% and
60% of sludge to agricultural lands (Eurostat 2011). The US EPA
(2012) estimates 50% of biosolids generated in the United States
are applied to agricultural lands. Aside from spreading on ag-
ricultural lands, other options for dealing with sludge include
incineration, landfilling, energy recovery, composting, and use of
incineration ash in concrete and brick (Wang et al. 2008). Discov-
ery of elevated concentrations of brominated fire retardants and
metals in sludge-applied soils in Sweden fueled an active contro-
versy and subsequent refusal by many farmers to apply sludge to
their fields. This significantly restricted the use of sludge in Swed-
ish agriculture (Bengtsson and Tillman 2004).
4.4. Nutrient losses
Approximately 25 Tg/year of reactive nitrogen is consumed in
food by humans; virtually all of this is excreted and lost to the air,
soil, or water (Galloway et al. 2008). There is no shortage of ni-
trogen on earth, but this is not the case with phosphorus. Current
rates of extraction of nonrenewable phosphate rock are forecast
to peak by 2035 and effectively exhaust currently known reser-
voirs in the next 8–10 decades (Cordell et al. 2011). Increasing
scarcity will likely drive up the price of phosphorus (van Vurren
et al. 2010). In addition to dramatic improvements in the effi-
ciency of phosphorus use in agriculture and food systems, nearly
100% recycling in various waste streams (including human excreta
and wastewater) will eventually be required to ensure adequate
phosphorus supplies (Cordell et al. 2011). Despite significant re-
ductions in effluent nutrient concentrations since the mid 20th
century, wastewater is still an important contributor to eutrophi-
cation of lakes, rivers, estuaries, and hypoxic zones at the mouths
of many major rivers worldwide (Jarvie et al. 2006; Robertson
and Saad 2011; Saeck et al. 2013; Rabalais et al. 2002; Diaz and
Rosenberg 2008).
4.5. Energy use and greenhouse gas emissions
Wastewater accounts for approximately 3% of total US energy
demand; approximately 0.6 Kw/h are required to treat one cubic
meter of wastewater, one half of which is required for aeration
basins in aerobic treatment plants (McCarty et al. 2011; US EPA
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6 Environ. Rev. Vol. 22, 2014

Table 3. Phosphorus reuse and loss in Linköping, Sweden, 1870–2000.

Reuse Loss
Year Sanitation method Plant fertilizer Animal feed Hydrosphere Landfill
1870 No sewage, urine collection 70% 15% 14% 0%
1900 No sewage, urine collection 61% 7% 32% 0%
1950 WC, no treatment, urine collection 5% 0% 85% 10%
1975 WC, treatment, sludge as fertilizer 15% 0% 10% 75%
2000 WC, treatment, sludge boycott 20%* 0% 3% 75%
Note: Plant fertilizer in 1870 and 1900 came largely from source-separated urine, whereas plant fertilizer in 1970
and 2000 is a product of sludge via the phosphorus removal unit at the wastewater treatment plant (WWTP).
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WC, water closet. Data is from Neset et al. 2010.

*70% of the fertilizer in 2000 was used for the energy forest (fuel wood).

Table 4. Wastewater (WW) as a proportion (by weight) of four major cities’ wastes.
Solid Air Total WW %
City Year(s) WW waste emissions weight of total Reference
Hong Kong 1997 102 2 4.8 109 94% Warren-Rhodes and Koenig 2001
Sydney 1990 128 0.8 9.3 138 93% Newman 1999
Toronto 1999 157 0.3 16 174 91% Sahely et al. 2003
Vienna 1990s 144 3 7 154 94% Hendricks et al. 2000
Note: Values for wastewater, solid waste, and air emissions are in tons per capita per year (t/capita/year). Data sources are listed in
the table.

2006). Greenhouse gas emissions associated with wastewater and
WWTPs occur in all phases of the wastewater process, including
methane emissions from anaerobic decomposition in sewers and
sludge, nitrous oxide emissions from nitrification/denitrification,
carbon dioxide emissions associated with fossil fuel based energy
For personal use only.
4.7. Human health risks
Human health risks associated with conventional sanitation
systems include (i) pathogen acquisition from direct contact with
water near wastewater outfalls from systems with primary treat-
ment only, (ii) pathogen acquisition from ingestion of food that

consumed in wastewater pumping and treatment and transporta-
tion of sludge (Kampschreur et al. 2009; Yusuf et al. 2012; Listowski
et al. 2011).
4.6. Toxics, metals, and micropollutants
Sewage sludge (or biosolids following treatment) and treated
wastewater are the two main sanitation-related sources of toxics,
heavy metals, and micropollutants (␮g/L or lower concentration)
(Kümmerer 2013; Remy and Jekel 2008; Toze 2006). Wastewater
treatment processes (such as activated sludge) may remove up to
85% of pharmaceuticals and personal care products (Kasprzk-
Hordern et al. 2009). However, Radjenović et al. (2009) found that
most pharmaceutically active compounds were still detected in
sludge applied to farmland and that none of the pharmaceutically
active compounds detected in untreated sludge were degraded
during sludge digestion. Numerous wastewater micropollutants
are frequently detected in WWTP effluents and surface waters
downstream from WWTP outfalls (Kolpin et al. 2002; Writer et al.
2013). These include bisphenol A (plasticizer), caffeine (stimulant),
carbamazepine (anti-seizure), codeine (analgesic), fluoxetine
(antidepressant) ibuprofen (anti-inflammatory), triclosan (anti-
microbial), tetracycline (antibiotic), tri(2-chloroethyl) phosphate
(fire retardant), and warfarin (anticoagulant).
Partial removal of pharmaceuticals and personal care products
from the wastewater stream has been achieved but requires one
or more of the following: increasing hydraulic retention time
(e.g., via holding ponds), physical (e.g., sorption) or chemical (e.g.,
oxidation) methods, or advanced biotechnology (e.g., membrane
bioreactor), all of which increase capital costs and possibly the
footprint of the WWTP by adding a fourth treatment step (Brandt
et al. 2013; Basile et al. 2011). Metals (copper, lead, zinc) tend to
accumulate in agricultural soils amended with biosolids or irri-
gated with wastewater. They may be taken up by food crops and
other biota and significantly alter soil microbial communities
(Alloway and Jackson 1991; Kalavrouziotis and Koukoulakis 2012;
Kelly et al. 1999). Biosolids may also contain and release additional
toxics that were not present in the original sludge, including en-
dotoxins from gram negative bacteria and volatiles such as am-
monia and sulfides (Lewis and Gattie 2002).
has been irrigated or fertilized with sewage-derived products,
(iii) inhalation of bacteria and toxics as dust from fields on which
biosolids have been spread, (iv) ingestion of heavy metal rich
vegetables grown on land irrigated with wastewater products,
(v) inhalation of volatiles and dust from WWTPs, and (vi) reduced
effectiveness of antibiotics due to proliferation of antibiotic resis-
tance genes and antibiotic resistant bacteria (Lewis and Gattie
2002; Arora et al. 2008; Cui et al. 2005; Pachepsky et al. 2011;
LaPara et al. 2011; Sterrit and Lester 1980).
5. Wastewater treatment as renewable resource
recovery
Resource recovery from combined wastewater streams does not
fit the definition of Chen and Beck (1997) of strong sustainability,
but such practices may meet the threshold of weak sustainability
in that resource recovery makes conventional sanitation less un-
sustainable. The literature on making incremental improvements
to existing WWTPs differs fundamentally from the source separa-
tion literature in that the discussion is focused on recovering
energy, nutrients, and water from commingled, rather than source-
separated wastewater streams. Although these three areas are
presented below in distinct sections, there are trade-offs between
energy use and greenhouse gas emissions, chemical consump-
tion, and the quantity and quality of recovered resources (Foley
et al. 2010). Besides energy, nutrients, and water there are many
other resources (e.g., metals, biopolymers) that could be recov-
ered from wastewater and byproducts; however, “a complete list
of potentially recoverable products and feedstocks does not cur-
rently exist” (Water Environment Research Foundation 2011, p. 6).
5.1. Energy recovery
Approaches to improving the energy balance in wastewater
treatment include (i) improving efficiency of treatment plant tech-
nology (the US EPA (2010b) provides a comprehensive evaluation
of existing and emerging technologies for reducing energy use in
pumping, aeration, treatment, and solids processing at WWTPs),
(ii) generating energy from the wastewater stream via methane
recovery, (iii) recovering latent heat for use in heating and cooling

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buildings, (iv) reusing wastewater as fertilizer (i.e., nutrient recov-
ery) to reduce fossil fuel use in extracting and producing nitrogen
and phosphorus fertilizers, (v) switch to anaerobic treatment pro-
cesses, (vi) move to smaller decentralized treatment plants to re-
duce energy needed to pump wastewater up-gradient for reuse,
and (vii) reduce the volume of water entering the WWTP (as well as
demand for potable water) by installing water conserving fixtures
(according to Proença et al. (2011) such an approach in Florianopo-
lis, Brazil, could result in saving up to 4 GWh of electricity annu-
ally, enough to power more than 1200 dwellings) (Guest et al.
2009; McCarty et al. 2011).
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Given currently widely installed aerobic treatment technolo-
gies, onsite generation (from methane) of one fourth to one half of
energy requirements may be possible. There is significant un-
tapped potential here: of the more than 500 US WWTPs of suffi-
cient size to employ combined heat and power generation, only
approximately 20% generate electricity or heat from onsite meth-
ane (US EPA 2007; McCarty et al. 2011). According to Rittmann
(2013) anaerobic processes (32%–92% efficient), however, are much
more efficient generators of energy from wastewater than aerobic
processes (7%–20% efficient). But due to the costs of retrofitting
existing aerobic plants, such an approach is likely only viable in
new construction scenarios (McCarty et al. 2011).
5.2. Nutrient recovery
Nutrient recovery in conventional WWTPs is determined and
limited by existing treatment systems, available technologies,
quality and concentration influent, and space and capital to ex-
pand or modify the WWTP. It should be noted that nutrient re-
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covery from wastewater is not the same as and typically requires
additional steps beyond nutrient removal, which has been the
focus of nutrient control measures over the past several decades.
Processes exist for nutrient removal and recovery at all stages in
the wastewater cycle: wastewater, concentrated wastewater, sludge,
incinerated sewage sludge, and primary treated effluent (Mulder
2003; Stark 2004; Water Environment Research Foundation 2011).
Discussions of the sustainability of such processes involve bal-
ancing several interrelated factors: (i) nutrient removal or recov-
ery efficiency, (ii) energy requirements, (iii) cost effectiveness,
(iv) emissions, and (v) chemical consumption (e.g., magnesium
used for struvite precipitation). Land area required to complete
removal and recovery and purity of the final product(s) (e.g., pres-
ence of metals or toxics) are also important considerations.
Cordell et al. (2011) report on two additional commercial-scale
methods of recovering phosphorus from wastewater and byprod-
ucts: (i) the Ostara fluidized bed reactor (Pearl Process) which
®
has been implemented in Portland, Oregon, USA (and elsewhere),
and recovers approximately 90% of phosphorus from the waste-
water stream, and (ii) the partnership between Dutch company
N.V. Sliberwerking Nord-Brabant (SNB) and Thermophos Interna-
tional, in which phosphorus is recovered from sewage sludge ash.
Both processes are cost effective and result in high quality products
but are also capital and energy intensive. In the case of Portland,
the product is Crystal Green struvite, magnesium ammonium
®
phosphate (MgNH4PO4·6H2O), which removes both phosphorus
and nitrogen from the wastewater stream. Potassium magnesium
phosphate (KMgPO4·6H2O, KMG), an alternative form of struvite
may be precipitated if most nitrogen has already been removed
via biological nutrient removal (Wilsenach et al. 2007).
Besides precipitation from wastewater, and recovery from
sludge or ash, there are also methods for recovering nitrogen as
ammonia from wastewater (Ammonia Recovery Process), and re-
covering nutrients in general from biomass (algae or duckweed)
grown in treatment ponds (Water Environment Research Federation
2011; Mulder 2003). Duckweed ponds’ nitrogen removal efficiency
is nearly identical to that of activated sludge with conventional
nitrification-denitrification (approximately 75%). Nutrients may
be recovered and reused from harvested biomass, and much less
7
energy is required to accomplish nitrogen recovery in duckweed
ponds than is required for nitrogen removal via conventional
nitrification-denitrification (Mulder 2003). However, a much larger
area is needed to remove an equivalent amount of nitrogen, and
duckweed ponds would likely not be active year-round in cold
climates.
5.3. Water conservation and reclamation
Numerous means of conserving water exist in society and gen-
erally fall into three major categories: (i) substitution, (ii) reducing
water use, and (iii) reclaiming and reusing water. The term substi-
tution refers to such practices as rainwater and stormwater har-
vesting for use in toilet flushing or irrigation (Grant et al. 2012).
Water use reduction may be accomplished by improving water
system efficiency (i.e., repairing leaks), improving water use effi-
ciency (e.g., low flow fixtures), or by eliminating water use cate-
gories (e.g., replacement of irrigated turf grass in arid regions)
(Grant et al. 2012). Over the past several decades, numerous
national (e.g., US EPA’s Water Sense program, Germany’s Blue
Angel, Australia’s Smart WaterMark) and local government pro-
grams (e.g., San Antonio, Texas, USA, and Sydney, Australia),
across developed nations have encouraged the use of low flow
plumbing fixtures. Results of these efforts include reductions in
demand from public water supplies, significant water savings,
and reductions in volume flowing through sewage pipes to
WWTPs. Water savings is a desirable outcome, but frequent re-
ductions below the minimum designed flow capacity over the
long term may damage sewer pipes, resulting, for example, in
increased sedimentation, corrosion, odor, and spikes in pollutant
concentrations when high flow events wash sediments from the
bottom of pipes (Larsen and Gujer 2013; Butler and Davies 2011).
Benefits of reclaiming and reusing TMWW include mainte-
nance of regional and local hydrologic cycles, maintenance and
restoration of biodiversity, reduction or prevention of effluent
discharge into surface waters, recycling of valuable nutrients and
organic matter, and reduction of the overall human footprint
(Grant et al. 2012; Guest et al. 2009; Levine and Asano 2004;
National Research Council 2012; Toze 2006). Water reuse in the
United States totals less than 1% of total water use, but TMWW
reuse has the potential to account for more than 25% of domestic
supply (Grant et al. 2012; National Research Council 2012). The US
EPA (2004b) estimated in 2002 that US water reuse was growing by
15% annually. If de facto reuse (communities downstream from
other urban areas) is considered, water reuse comprises a much
more significant proportion of domestic and total water supply in
the United States (National Research Council 2012). Some 21 mil-
lion m3 of TMWW is reused daily in 43 nations; more than one
third of this volume is accounted for by the United States alone.
Reused TMWW accounts for more than 10% of the water demand
in five nations (Kuwait, Israel, Cyprus, Qatar, and Singapore), all
of which are nations with extreme water scarcity (Jimenez and
Asano 2008).
Applications for water reuse include nonpotable and two types
of potable: indirect (reuse following infiltration or groundwater
injection/recharge) and direct (reuse immediately after wastewa-
ter treatment). Nonpotable uses include industrial cooling and
process water, agriculture and landscape irrigation, and ground-
water recharge and saltwater intrusion protection; notable exam-
ples of these practices in the United States include the Orange
County (California) Water District and the Upper Occoquan (Vir-
ginia) Sewage Authority (Guest et al. 2009; National Research
Council 2012). Windhoek, Namibia, has the longest running direct
potable reuse program worldwide (National Research Council
2012; Guest et al. 2009). No direct potable reuse projects are oper-
ational in the United States. Whereas most major European cities
(more than 2000 as of 2005) have indirect potable water projects
in place, there are very few direct potable projects (Bixio et al.
2006).
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8 Environ. Rev. Vol. 22, 2014

Fig. 3. Attitudes toward various uses of recycled wastewater in three developed nations. Values are the proportions of the sampled
population who agree with, are willing to use water for, or who answered yes or probably yes for specific uses noted, respectively, in the three
studies noted below. *Kantanoleon et al. (2007) describe this category more broadly as “sport field irrigation.” †The percentage is an average of
two categories: animal crops (20%) and industrial crops (23%).
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For personal use only.

Recent studies of urban populations in Australia, Greece, Israel,
and the southeastern United States indicate that wastewater reuse
is more acceptable when (i) there is low probability of direct con-
tact with the wastewater, (ii) wastewater is not used directly on
food or to augment the potable water supply, and (iii) people have
the opportunity to reuse their own wastewater, i.e., not from a
common treatment plant (Fig. 3, Escobar 2010; Dolnicar and
Schäfer 2009; Kantanoleon et al. 2007; Khan and Gerrard 2006;
Friedler et al. 2006; Robinson et al. 2005). The significantly lower
interest in wastewater reuse reported in the study in Greece may
be due to fear of toxins that cannot be removed by wastewater
treatment technologies or general mistrust of public authorities
(Kantanoleon et al. 2007). Hartley (2006) also finds that public
trust and transparency are vital to the success of TMWW reuse
projects.
6. Source separation and decentralization (SSD)
SSD is the latest designation for alternative sanitation concepts,
which have been discussed in the peer-reviewed literature since
the early 2000s as ecological sanitation (eco-san) and also as de-
centralized sanitation and reuse, or DESAR (Esrey 2002; Lens et al.
2001; Larsen et al. 2013). The most widely cited source of the term
ecological sanitation appears to be the Swedish International De-
velopment Cooperation Agency’s report titled Ecological Sanitation,
which was focused on developing nations (Esrey et al. 1998). Re-
search on applying SSD in developed nations ensued and groups
(such as the Netherlands’ Foundation for Applied Water Research)
have coined terms (e.g., Niewe Sanitatie, or New Sanitation) to
help broaden societal discussions of sanitation and alternatives to
conventional sanitation (Swart and Palsma 2013).
The basic premise of SSD is that valuable resources in human
excreta can be best recovered by keeping waste streams separate
and minimizing or eliminating the use of water as a waste trans-
port vehicle (Larsen et al. 2009). In so doing, industrial effluents
and domestic excreta are not mixed and domestic blackwater,
kitchen waste, and greywater are to varying degrees also stored
and treated separately. Nutrient cycles are closed (i.e., recon-
nected with agriculture), organic matter is recovered or processed
into energy, and soil quality is maintained; there is no connection
between waste or residue water and surface water bodies, and
most of the water entering human settlements is recycled/recharged
(Fig. 4, Langergraber and Muellegger 2005; Larsen et al. 2009; Wang
et al. 2006; Werner et al. 2009). Of course, under the existing food
system, additional nutrients besides those recovered from human
excreta would still be required to ensure an adequate food supply.
6.1. SSD models
There are many possible configurations of SSD systems, ranging
from self-contained onsite systems to neighborhood-scale treat-
ment centres to hybrid systems in which some functions (separa-
tion, collection, storage of urine) are performed onsite and others
(e.g., greywater treatment) at centralized locations (Magid et al.
2006; Hellström et al. 2008; Langergraber and Muellegger 2005;
Werner et al. 2009; Larsen et al. 2009; Tchobanoglous and Leverenz
2013; Vinnerås and Jönsson 2013). Magid et al. (2006) evaluate
several options for combining source separation and existing cen-
tralized facilities (Figs. 5a–5c) for increasing cycling of organic
matter and nutrients from the town of Hillerød, Denmark, back to
the countryside. They find that although implementing a combi-
nation of the alternatives would cost more than the current sys-
tem, energy gained in the process would more than make up for
added costs. Tilley (2013) argues that dividing sanitation systems
into functional groups comprised of stakeholders, technologies,
and functions may be an effective way to conceptualize decentral-
ized systems (Table 5).
6.2. User interface
In conventional sanitation, the user interface normally repre-
sents the only connection between users and the sanitation sys-
tem. When using conventional fixtures, smell and visibility of and
contact with excreta is extremely limited, and attempts have been
made to replicate this experience with urine separating toilets
that operate much like conventional flush toilets. Source separat-
ing toilets also include composting (dry and wet) and vacuum
models, which may be directly attached to individual compost
chambers and urine storage tanks, or to larger piping and col-
lection systems. There is no specific set of technologies that fits
exclusively within the paradigm of SSD; Langergraber and

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Fig. 4. Conceptual diagram of ecological sanitation/source separation and decentralization. Arrows are nonquantitative representations of
resource (water, nutrients, organic matter) flows associated with sanitation and connected processes. Adapted from Werner et al. (2009), with
permission from Elsevier.
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Muellegger (2005) stress that sanitation technologies themselves
are not sustainable per se, but rather only in relation to how they
are used in their immediate environment, which includes hu-
mans and our preferences about cost, fixture design, and aesthet-
ics. Although toilets and urinals may seem as though they are
among the simpler components of sanitation systems, there does
not yet appear to be a widely accepted urine-separating model (the
Roediger NoMIx toilet looks and operates much like a standard
flush toilet except that a urine collecting basin is installed in the
front of the toilet; this toilet is no longer being manufactured).
6.3. Collection, storage, and conveyance
For storing and conveying source-separated urine, Larsen et al.
(2009) argue that although it is possible to install separate pipes
for centralized urine collection, on site decentralized technolo-
gies are the most feasible for treating and storing separated urine
for three reasons: (i) some type of source separating technology is
already necessary on site, (ii) significant improvements have been
made lately in source separating technologies, and (iii) wastewater
professionals have expressed low interest in investing in treat-
ment technologies for source-separated urine at the WWTP. If
feces are separated at the toilet and stored separately from urine
and greywater, they must also be conveyed and treated separately;
whereas blackwater can be transported via sewer pipes, feces
alone cannot and must be transported via truck or vacuum system
(Tilley 2013).
6.4. Treatment of and fertilizer products from source-
separated streams
Domestic wastewater is comprised of three main waste streams:
(i) urine, which contains approximately 80% of the nitrogen, 45% of
the phosphorus, and 70% of the potassium loads; (ii) feces, which
contains the majority of heavy metals in excreta, lower amounts
of nitrogen, phosphorus, and potassium, and most of the micro-
bial load; and (iii) greywater, which despite being highly diluted
has the majority of the chemical and biological oxygen demand
total organic carbon, and sulfur but is relatively poor in macronu-
9
trients nitrogen, phosphorus, and potassium (Table 6, Friedler
et al. 2013). Greywater may be further divided into light greywater
(water from showers, baths, and wash basins) and dark greywa-
ter (mainly kitchen waste) (Friedler 2008).
6.4.1. Source-separated urine
Of the fertilizer products that can be derived from human ex-
creta, stored urine is by far the most studied to-date as it contains
an estimated 60%–90% of excreted nutrients, can easily be sepa-
rated, and is in most cases sterile following 6 months’ storage
(Jönsson and Vinnerås 2013; Winker et al. 2009; Kirchmann and
Pettersson 1995). The long storage time is recommended because
urine may be cross-contaminated with fecal matter during collec-
tion in urine separating toilets, and infected individuals may also
pass helminth (e.g., Ascaris) eggs via urine (Decrey et al. 2011;
Stenström 2013). Pathogen survival in urine is enhanced by dilu-
tion with water and diminished by higher temperature, higher
pH, and longer storage time (Chandran et al. 2009; Höglund et al.
2002; Nordin et al. 2009; Vinnerås et al. 2008). In stored urine, urea
decomposes to ammonia over a period of weeks, reaching an
approximate pH of 9 (Liu et al. 2008; Kirchmann and Pettersson
1995). Storage time recommendations for inactivating pathogens
in undiluted urine range from weeks (bacteria) to months (vi-
ruses) at temperatures of at least 15 °C (Orumwense et al. 2013;
Chandran et al. 2009; Höglund et al. 2002). To prevent loss of
ammonia-nitrogen to the atmosphere, care must be taken to com-
pletely seal urine storage tanks and to immediately incorporate
urine into soil in which it is applied (Kirchmann and Pettersson
1995).
Nutrients may also be recovered from urine via concentration/
evaporation or precipitation as struvite following hydrolysis of
urea to ammonia (Kabdaşli et al. 2013; Ganrot et al. 2009). Advan-
tages of struvite over liquid urine include increased concentration
(due to reduced volume and mass), the absence of nearly all micropo-
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10 Environ. Rev. Vol. 22, 2014

Fig. 5. Representative source separation and decentralization (SSD) models that incorporate existing infrastructure. (a) Greywater and feces
are transported via sewer pipe to sewage plant. Urine is collected and transported to larger storage tanks for later use in agriculture. Kitchen
waste is collected and transported to biogas plant for treatment and energy recovery. (b) Greywater is transported via sewer to sewage plant.
Kitchen waste, urine, and feces are stored locally and transported to biogas plant for treatment and energy recovery. (c) Greywater is
separated into liquid (infiltrated) and solids (trucked to sewage plant). Urine is collected and stored for use in garden. Kitchen waste and feces
are composted for use in garden. Redrawn from Magid et al. (2006), with permission from Elsevier.
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Table 5. Functional groups for describing sanitation systems.

Group Stakeholders Technologies Key functions
User interface Homeowner Toilets (urine separating), urinals, taps, Determine volume, concentration, and
appliances composition of products requiring
storage and treatment
Collection and Homeowner Pipes, storage tanks Hold intermediate products, hygienization
storage (of urine)
Conveyance Public utility or private enterprise Pipes, trucks Move products between sanitation “nodes”
Treatment Homeowner, public utility, or private Filtration, sedimentation, precipitation Change characteristics of products (e.g.,
enterprise dehydration, disinfection)
Use and Public utility and (or) private Solid spreading equipment, pelletizer, urine Distribute products (e.g., urine as
disposal enterprise applicator, incinerator, biogas plant fertilizer)
Note: Summarized from Tilley (2013).

llutants (pharmaceuticals, endocrine disrupting compounds, and
heavy metals), and, following exposure to low humidity and ultravi-
olet radiation, the effective elimination of any remaining pathogens
(Ronteltap et al. 2007; Decrey et al. 2011; Escher et al. 2006). Despite
the significant progress made on source-separated urine, Karak and
Bhattacharyya (2011) urge further investigations of fate and transport
of pharmaceuticals and byproducts and of pathogens in urine, a
subject that remains understudied.
6.4.2. Blackwater and feces
Blackwater tends to be more challenging to sanitize and reuse
than urine because feces (or urine + feces) are more diverse in
composition (largely water, organic matter, and microorganisms)
than urine, and fecal composition varies according to diet,
amount of water present, climate, and other variables (Otterpohl
and Buzie 2013). High storage/process temperatures and long re-
tention times diminish survival of pathogens, as do low humidity,

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Table 6. Selected compounds in urine, feces, and greywater.
Compound Urine Feces
Water (%) 95 77
Total suspended solids (g) — 22
Biological oxygen demand (g) 5.8 12
Chemical oxygen demand (g) 13 31
Total organic carbon (g) 4.3 3.5
Total nitrogen (g) 11 1.5
Total Phosphorus (g) 0.93 0.6
Potassium (g) 2.6 0.9
Sulfur (g) 1.3 0.61
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Lead (␮g) 2 20
Copper (␮g) 103 1110
Mercury (␮g) 1.9 8.3
Zinc (␮g) 46 11
Note: Values are averages of data reported in Friedler et al. (2013), Tables 17.3
and 17.5.
dehydration of solids, and high alkalinity (Austin and Cloete 2008;
Nordin et al. 2009). Winker et al. (2009) classify concentrated
urine and struvite as products that are somewhat known, whereas
fertilizer products derived from the solid phase are all classified as
unknown (or relatively understudied) and include liquid and solid
organic substances such as digestate, compost, and treated and
untreated sludge.
Blackwater and feces may be treated by such “high-tech” meth-
ods as continuous stirred bioreactors, upflow anaerobic sludge
blankets, and such “low-tech” methods as composting, vermicom-
posting, Terra Preta sanitization, dehydration, and pasteurization
For personal use only.
(Udert and Jenni 2013; Otterpohl and Buzie 2013). Membrane pro-
cesses (reverse osmosis, nanofiltration, ultrafiltration) are appro-
priate for treating blackwater from which most solids have been
removed, but pretreatment is necessary; with this process can
come a number of challenges, including maintaining consistent
flow and cleaning membranes and filters clogged or damaged by
large particles (Leslie and Bradford-Hartke 2013).
6.4.3. Greywater
Greywater is characterized by highly variable concentrations of
contaminants (including surfactants, greases, oils, and various
xenobiotics and pathogens) of generally low biodegradability,
with biological oxygen demand ranging from 5–900 mg/L, and
comprises the lion’s share (60%–70% by volume) of domestic
wastewater (Travis et al. 2010; Jefferson and Jeffrey 2013; Friedler
2004). Under current water use patterns, the supply of greywater
is much greater than the potential demand (use in toilet flushing
or garden watering) (Friedler 2004). Direct reuse of greywater
without appropriate treatment may compromise human health
due to contamination with fecal matter (e.g., from showers and
bathing) and kitchen waste, and the risks to human health and
environment associated with greywater use are not well studied
(Maimon et al. 2010). Pathogens found in greywater may include
coliforms, Pseudomonas, Staphylococcus, Giardia, Cryptosporidium,
and Legionella (Jefferson and Jeffrey 2013). Xenobiotics found in
greywater are typically components of personal care products and
include surfactants, fragrances, parabens, and biocides. Some of
the more persistent xenobiotics include tonalide and UV filters,
both of which have been shown to be potent endocrine disrupters
in multiple species (Leal et al. 2010).
Environmental impacts of direct greywater reuse may include
alteration of soil properties (such as hydraulic conductivity), con-
tamination of groundwater through leaching, reduction in plant
growth through alternation of soil or the propagation of chemi-
cals (e.g., borax) that are poisonous to plants introduced in grey-
water (Leal et al. 2010; Maimon et al. 2010). Given its highly diverse
and variable nature, and depending upon the desired end use for
reclaimed greywater, treatment may require organics and patho-
gen removal (via membrane bioreactor or vertical flow reed beds
11
with chlorine or UV disinfection) and xenobiotics removal via
Greywater adsorbtion and biodegradation (Jefferson and Jeffrey 2013).
>99 6.5. Reuse and disposal
19
6.5.1. Human excreta as fertilizer
19
51 Research on staple food crops and vegetables including maize,
8.4 sorghum, tomatoes, cucumbers, beets, cabbage, okra, sweet pep-
0.9 per, and spinach indicates that use of urine as fertilizer results in
0.5 yields and overall produce quality that is comparable with or
0.3 better than that achieved via use of mineral fertilizers (Pradhan
2.9 et al. 2010; Germer et al. 2011; Pradhan et al. 2007; Pearson et al.
— 2008; Heinonen-Tanski et al. 2007; Apan-Idiok et al. 2012; Shrestha
— et al. 2013; Kutu et al. 2010). Supplementing urine with wood ash
— may further improve yields in beets; however, for some crops
— (such as sorghum) additional supplements of potassium and phos-
phorus may be required to optimize yields (Pradhan et al. 2010;
Germer et al. 2011). Use of high rates of urine as fertilizer may
result in increased soil pH and salinity and may not be recom-
mended for salt sensitive crops such as carrots (Pearson et al. 2008;
Tidaker et al. 2007; Germer et al. 2011). Potential multi-year im-
pacts of urine fertilizer on soils, nitogen, phosphorus, microflora,
crop yield, and organic matter appear to remain unexamined.
Although urine contains most of the pharmaceutically active
compounds and natural estrogens and androgens in human ex-
creta (Khan and Nicell 2010; Liu et al. 2009), few studies have
examined fate and transport issues associated with micropollut-
ants in urine used as fertilizer. In their greenhouse study, Winker
et al. (2010) examined the fates of ibuprofen and carbamezipine
applied in spiked urine to soil in which ryegrass was grown.
Whereas more than one third of the applied carbamazepine was
found in aerial plant growth, ibuprofen completely biodegraded
in soil within 3 months and was not detected in plant tissues.
Studies on the use of urine plus composted feces as fertilizer
indicate comparable and in some cases superior performance to
that of urine alone; however, issues surrounding pathogen intro-
duction into the food supply via composted feces require further
examination (Shrestha et al. 2013; Kutu et al. 2010). The use of
composted feces alone does not provide sufficient available nutri-
ents to compete with either urine or mineral fertilizer on plant
yield and biomass (Mnkeni and Austin 2009). Several relative un-
knowns surround the use of composted feces as a fertilizer or soil
conditioner in field experiments; these include pathogen survival
in composted feces and in crops grown in compost-amended soils,
long-term impacts of application of composted feces to soils, and
the fate and transport of micropollutants present in composted
feces.
6.5.2. Biogas production from human excreta
Though biogas production is an important part of most SSD
models, there has been much less published research on this topic
than on the use of excreta in agriculture. In developing nations
there are hundreds of thousands of small-scale anaerobic biogas
digesters utilizing both human and animal excreta and crop re-
siduals, but this is not the case in developed nations. The over-
whelming majority of biomass in the United States is made up of
crop and timber residuals and switchgrass; approximately five-
fold more biomass is available in animal excreta than in wastewa-
ter. Biomass in wastewater or excreta makes up less than 1% of the
total biomass available in the United States, but biogas produced
from excreta could be an important local source of energy
(Milbrandt 2005). In their recent study, Appels et al. (2011) indicate
that sewage sludge (a significant proportion of which is human
feces) has the highest energy density of any biomass feedstock
worldwide. As noted above, there are some WWTPs that generate
and utilize methane onsite, but this is limited due to the prepon-
derance of aerobic treatment systems that convert only a small
proportion of organics into methane. A major focus in Europe has
been to develop and commercialize biogas plants for the purpose
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12
of treating and recovering energy from food waste and separated
municipal solid waste; more recently, there have been efforts to
establish biogas plants that are co-digesters of animal excreta,
crop residues, and human excreta or biosolids (Nichols 2004;
Nielsen et al. 2009).
6.6. Pilot studies on SSD
Many of the early pilot studies on SSD-related concepts were
done in small ecovillages in northern Europe; however, there
have now been several urban case studies on SSD published as
well. The bulk of the case studies described in the literature are
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
concentrated in only a few nations, most notably in Sweden,
which is recognized as the pioneer and leader in SSD implemen-
tation, with over 120 000 urine diverting (UD) systems installed,
most of which practice dry fecal sanitation (Vinnerås and Jönsson
2013). Germany, Switzerland, Australia, and the Netherlands
are also actively researching and implementing SSD projects
(Londong 2013; Gardner and Sharma 2013; Boller 2013; Mitchell
2006). Pilot projects have been implemented in individual homes,
villages, universities, museums, and other workplaces. According
to reports in the published literature, some projects have failed
prior to implementation and some have failed following imple-
mentation, but most projects mentioned have achieved at least
some measure of success (van Vliet et al. 2011; Fittschen and
Niemeczynowicz 1997). Most SSD projects involve UD, but several
other types of projects exist, including ecovillages (e.g., Toarp
Ecovillage, Sweden) installing dry composting toilet systems, of-
fice buildings (GTZ headquarters, Eshbon, Germany) installing UD
toilets, and farmers who are contracted to collect urine, blackwa-
For personal use only.
ter, and sludge from households (Tanum, Sweden) (Werner et al.
2009; Fittschen and Niemeczynowicz 1997; Vinnerås and Jönsson
2013).
Challenges associated with many if not most of the pilot source-
separating projects appear to be related to user behavior, educa-
tion about the use and maintenance of decentralized sanitation
technologies (for example, how often and how much bulking
agent to add to composting toilets, how to clean urine separating
toilets and avoid struvite scaling and blockage of valves and
pipes), unforeseen technical difficulties, fixture and system de-
sign, planning and fit between dwellings and installed sanitation
systems, and ownership and buy-in (Hanaeus et al. 1997; Fittschen
and Niemeczynowicz 1997; Otterpohl et al. 1997; Langergraber
and Muellegger 2005; Boller 2013). With the notable exception of
the work summarized by Lienert and Larsen (2010), articles detail-
ing case studies are largely descriptive and difficult to compare
across cases because of diverse locations, technologies, and a lack
of common evaluative measures.
Lienert and Larsen (2010) reviewed urine source separation proj-
ects implemented in seven European nations, including Austria,
Denmark, Germany, Luxembourg, the Netherlands, Sweden, and
Switzerland. Settings for the studies varied and included house-
holds and workplaces, but urine separating toilets were standard
in all of the studies. Of the participants in the studies, nearly 85%
regarded urine separating toilets as a good idea, and nearly 80%
would welcome such toilets at work or in the home. Urine sepa-
rating toilets were rated higher in categories related to perception
of the toilet (design, hygiene, and smell) than on aspects of oper-
ating the toilet (flushing and cleaning): only 65% of participants
indicated a positive attitude for flushing, and only 53% for clean-
ing (Lienert and Larsen 2010, Fig. 6). Results for cleaning varied
significantly among participants from different nations: 100% of
participants from the Netherlands had a positive attitude toward
cleaning, compared with less than 60% of participants from other
nations. Also of note are significant differences between studies in
what Lienert and Larsen (2010) term behavior adequate for urine
separating toilets. For example, 100% of study participants in Ger-
many but less than 60% of participants in Austria had a positive
attitude towards sitting to urinate. Some of the studies reviewed
Environ. Rev. Vol. 22, 2014
Fig. 6. User perceptions (percent of users with positive attitude) of
urine separating compared with conventional toilets. Weighted
average values below were calculated from data reported by Lienert
and Larsen (2010, Fig. 1A–D) who compiled responses from
33 studies (total n = 2270) of urine source separation projects.
by Lienert and Larsen (2010) also addressed public and farmer
attitudes toward urine fertilizer, and indicate that in comparison
to farmers, urine separating toilet users had a much more positive
attitude toward urine fertilizer.
7. Wanted: social science perspectives
To successfully adopt, finance, install, operate, and maintain
decentralized sanitation systems or retrofit existing sanitation
systems, the enthusiastic participation of numerous stakeholders
(e.g., end users, water resource professionals, designers, manufac-
turers, utility managers, farmers, local, regional, and national
politicians) is required. The importance of a fundamental shift in
the way society conceives of sanitation and the input of social
science perspectives, therefore, cannot be understated. However,
as van Vliet et al. (2011) assert, the literature on sustainable sani-
tation is dominated by engineering and natural science perspec-
tives and as evidenced by the literature search conducted in
preparing this paper: “…sanitation has so far only scarcely been
addressed…from a social science perspective” (p. 798). Jewitt
(2011) argues “…greater emphasis on sanitation “software” in dif-
ferent geographical contexts is urgently needed if local human
waste management preferences are to be understood and appro-
priate solutions are to be found…” (p. 620). User acceptance and
attitudes toward sanitation (e.g., TMWW reuse or alternative toi-
lets) is but one of the important areas in need of attention: impor-
tant questions concerning sanitation governance and financing,
and mechanisms for innovation and transition from existing san-
itation models must also be addressed. Van Vliet et al. (2011) sug-
gest evaluation based on a “modernized mixtures” approach in
which systems are assessed on such variables as scale, consumer
involvement, and degree of centralization in addition to physical/
technical capabilities. Literature from three interrelated social
science areas (emotions, regulation and innovation, and econom-
ics) in need of further inquiry is reviewed below.
7.1. Behavioral psychology and sustainable sanitation
The behavioral psychology literature suggests that the emotion
of disgust has a significant influence on attitudes and perceptions
toward sanitation and excrement. Defined as a feeling of revul-
sion associated with realized or perceived ingestion of offensive
contaminants, disgust becomes stronger with increasing proxim-
ity of offensive objects to the mouth. This association is not innate
but rather learned between the ages of 3–7 at about the time of
toilet training (Rozin et al. 2008). According to Rosenquist (2005),
“…the natural reaction to the emotion of disgust…is avoidance
behavior, and…this includes both physical contact with excre-
ment as well as the smell and sight of it” (p. 339). Changes in
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 Pagination not final (cite DOI) / Pagination provisoire (citer le DOI)
Brands
systems, technologies, or behaviors that result in decreasing the
actual or perceived distance between ourselves and our excre-
ment (or that of others) may, therefore, trigger significant resis-
tance (there is considerably more aversion to bodily odors
associated with strangers than to odors associated with close fam-
ily members or oneself (Stevenson and Repacholi 2005; Rozin
et al. 2008)), as Haslam (2012) explains “Despite its importance,
excretion is something that people rarely want to think about.
Instead we try to put the greatest possible physical and psycho-
logical distance between ourselves and our waste. We prize the
technologies we have invented for doing so, even if they are often
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
taken for granted and hidden from view.” (p. 2).
The intensity of disgust associated with sight or smell of excreta
is not uniformly distributed across the population, and appears to
be modulated by profession, parenting style, age, education, psy-
chopathy, number of children, gender, and income (Templer et al.
1984; Corgiat and Templer 2003; Ely et al. 2007). Corgiat et al.
(1986) demonstrate that those employed in professions (e.g., nurs-
ing, farming) in which there is frequent interaction with excre-
ment (human or otherwise) tend to find excrement less disgusting.
Identifying relevant characteristics associated with “early
adopters” based on their life experiences and orientation toward
excreta is an intriguing area for future work. In their study of
Australians, Dolnicar and Schäfer (2009) found that “strong ac-
cepters” of recycled wastewater tended to be managers or admin-
istrators that were older and more highly educated and watched
more state-run television channels than average. Could some of
the same characteristics of recycled wastewater accepters also be
indicators of interest in or adoption of SSD-related technologies
For personal use only.
and systems? And, even more importantly, could knowledge of
such characteristics be beneficial in devising public education
programs on sanitation?
Van Vliet et al. (2011) and van Vliet and Spaargaren (2010) assert
that sanitation practices in which excreta become more visible (or
resensitized) have a steep yet not insurmountable challenge for
adoption. Hegger and van Vliet (2010) argue that factors such as
user involvement, functionality, and dependencies between users
are important variables for analyzing sanitation innovations. The
interaction between personal characteristics such as strength of
disgust emotion and variables associated with innovative sanita-
tion systems (e.g., citizen-driven vs. developer-driven, or high user
involvement vs. low user involvement) may also be a fertile area
for further inquiry.
7.2. Drivers of innovation and regulation
Choices available to end users are, in large part, determined by
innovation and regulation, which is a second major social science
area of emphasis within the context of sustainable sanitation.
Fam and Mitchell (2012) argue that “…in the adoption of new
sanitation concepts, other necessary components of the system
include new regulatory structures, institutional arrangements as
well as the development of infrastructural capacity to collect,
store, transport and reuse urine in agriculture” (p. 9).
Development of such capacity requires powerful drivers, one of
which appears to be applicable to all developed nations: the im-
pending age of replacement for centralized wastewater infra-
structure that was installed over the past 150 years (Baird 2011;
Swart and Palsma 2013). Other drivers for exploring alternative
modes of sanitation vary widely across nations and depend in part
upon resource scarcity (water, phosphorus), pollution problems
such as eutrophication, and societal awareness of sustainability
issues (Vinnerås and Jönsson 2013; Swart and Palsma 2013; Gardner
and Sharma 2013).
Further improvements and expansion of on-site treatment sys-
tems to support SSD will require institutional and regulatory
changes, industry changes to support new business models (e.g.,
inclusion of marketing, installation, repair of on-site technolo-
gies), integration of technologies into the whole-house water sys-
13
tem, and increased public and institutional awareness of on-site
treatment and SSD (Truffer et al. 2013). Potential reorientation of
contractual/legal responsibility and associated business models
for sanitation may be viewed as disruptive by existing publicly or
privately owned WWTPs (Londong 2013; Truffer et al. 2013). With
regard to agricultural use of human excreta in Europe, there
are currently conflicting and inconsistent national and supra-
national policies. For example, in Sweden the Baltic Sea Action
Plan encourages nutrient reduction to alleviate eutrophication,
but does not specifically support urine diversion (UD). Human
feces and urine are not permitted for use in agriculture in Ger-
many (Londong 2013). And whereas European Union regulations
do not allow the use of human excreta on organic foodstuffs,
Swedish national regulations permit the use of human urine as
fertilizer on organic farms (European Commission 1991; Fam and
Mitchell 2012). The status of policies related to human excreta as
fertilizer is perhaps not unexpected given that there are also a
variety of TMWW reuse (much more widely accepted and prac-
ticed) regulations and guidelines in Europe and within the United
States (Bixio et al. 2006; Tchobanoglous et al. 2003).
7.3. Economics of sanitation
There are a limited number of studies that delve into questions
of economics in the context of source separation. For example,
Anand and Apul (2011) compared for two existing University of
Toledo buildings the modeled cost, energy, and global warming
potential of standard versus decentralized sanitation approaches.
There were three options that outperformed standard toilet and
urinal fixtures: (i) low flow fixtures, (ii) rainwater harvesting plus
low flow fixtures, and (iii) waterless composting toilets, which
over a 50 year life cycle had the lowest energy demand, carbon
footprint, and cost. However, the analysis did not cover issues
(e.g., cost, disposal, transportation) with solids management that
would likely be the purview of those operating the composting
toilets. Nakagawa et al. (2012) compared the costs and energy
requirements associated with existing versus UD toilets in two
public toilet service areas in Japan. The UD toilet systems were
estimated to reduce nitrogen and phosphorus by 94% and 79%,
respectively; the payback period for energy use for each was 0.3
and 0.8 years and for cost was 2.8 and 12.6 years. The shorter
payback period is due to 10–12 times more users per year at one of
the toilet service areas.
Thibodeau et al. (2011) used an economic life cycle analysis
model to compare the costs of source separation systems and
conventional systems at three different scales: 500, 5000, and
50 000 inhabitants. An inverse relationship was found between
community scale and cost of implementing source separation (al-
though this same relationship certainly exists for centralized sys-
tems as well). The source-separating system cost 33%–118% more
than conventional systems; Thiboudeau et al. indicate that reduc-
ing the flow through vacuum toilet systems or implementing a
volume reduction technology could narrow the cost gap between
conventional and source-separating systems. Larsen et al. (2009)
argue that although there may not be economy of scale in SSD,
there could be economy of numbers — referring to the mass
production of decentralized technologies. One national-level
study of selected developed nations indicated that per capita
investments of US$260–680 (for communities with existing
systems) or US$640–2170 (for communities without sanitation sys-
tems) would be necessary to provide decentralized systems with
comparable performance to conventional systems (Maurer et al.
2006).
In the context of conventional sanitation, the provision of
wastewater treatment has historically been significantly under-
valued, and utilities struggle to recover the full costs of capital,
operation, maintenance, and other services, which is a significant
threat to their overall sustainability (see, for example, Renzetti
and Kushner (2004) who document the understatement of water
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 Pagination not final (cite DOI) / Pagination provisoire (citer le DOI)
14
and sewage utility services by 18%–55% in Niagara, Ontario, Can-
ada). One of the fundamental hurdles for adopting SSD or other
alternative sanitation approaches is high cost of capital, opera-
tion, and maintenance compared with that of conventional sani-
tation. However, Maurer (2013) argues that estimating the full cost
or value of wastewater infrastructure is difficult because it has
grown “organically” over time, which makes it difficult to deter-
mine what a comparable cost for decentralized technology would
be. Furthermore, economies (from denser population) and disec-
onomies (larger pipes needed for larger flows) of scale and uncer-
tainty about future capacity needs are additional variables that
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
may only be accurately balanced in the context of a specific urban
geography.
8. Conclusions
Both SSD and conventional sanitation present significant op-
portunities and challenges when it comes to achieving sustain-
able sanitation. But comprehensive comparisons of conventional
sanitation and SSD are difficult for several reasons, including the
absence of full-scale urban implementations of SSD and narrower
system boundaries for research on and discussion of conventional
sanitation than for SSD. In addition, SSD duplicates some func-
tions of conventional sanitation but also provides added function-
ality (e.g., fertilizer products) as well as issues (e.g., transport of
fecal matter without the use of water, multiple potential human
contact points) not present in conventional sanitation (Winker
et al. 2009; Tilley 2013; Stenström 2013). There are also issues (such
as pharmaceuticals and personal care products) that neither ap-
proach to sanitation fully addresses, and for which additional
For personal use only.
strategies (such as re-examining prescription and consumption
habits or redesigning pharmaceuticals and personal care products
via “green chemistry”) may be necessary (Kümmerer 2013). To
facilitate the comparison of various sanitation system configura-
tions, and to track progress toward sustainable sanitation, a com-
prehensive set of sustainability benchmarks and goals (e.g.,
nutrient and energy recovery, economic viability, water quality
protection, and many others) is needed.
Analytical tools (such as risk analysis, life cycle analysis, urban
metabolic studies, and multi-criteria decision analysis (e.g.,
Lienert et al. 2011)) may be employed to establish goals and bench-
marks, and to evaluate SSD, conventional sanitation, and hybrid
sanitation models. But the prospective success of such efforts de-
pends, in large part, upon effective multidisciplinary cooperation.
Much of the progress thus far on SSD is owed to intentionally
transdisciplinary multi-year efforts such as the 2000–2006 Swiss
Novaquatis project (http://www.novaquatis.eawag.ch/index_EN)
on urine source separation, which included teams devoted to user
acceptance, sanitation technology, storage and transport, treat-
ment and fertilizer production, and micropollutants, and resulted
in over 40 peer-reviewed publications. The significant sanitation
challenges at hand require expanding upon such efforts through
the inclusion and cooperation of researchers in the social, natu-
ral, and health sciences, engineers, policymakers, and the various
stakeholders throughout the sanitation chain, or eventually the
sanitation loop.
A general broadening of the geographical and societal scope of
research is needed, for example, in the context of attitudes toward
sanitation. As of yet, there has been only one peer-reviewed survey
of attitudes toward decentralized sanitation in the United States
(i.e., Lamichhane and Babcock (2013) surveyed a subset of the
University of Hawaii population regarding receptiveness to urine
diversion and recycling). Much of the work thus far on public
attitudes toward TMWW reuse has been conducted in arid regions
(e.g., Greece, Israel, Australia, and the southwestern United
States), but there are also TMWW reuse programs in nonarid re-
gions such as metropolitan Atlanta, Georgia, USA, and through-
out much of Europe. The existing literature focuses mainly on
Environ. Rev. Vol. 22, 2014
specific populations attached to an institution (e.g., university) or
end-users participating in pilot studies with decentralized sanita-
tion technologies, with some surveys of farmers and case studies
on wastewater professionals (see, for example, Lienert and Larsen
2010; Lienert et al. 2006; Schosseler et al. 2007). An understanding
of current prevailing attitudes in broader society is necessary to
determine (i) the level of acceptability of a range of sanitation
approaches and technologies, and (ii) the characteristics of those
more or less likely to accept changes.
Significant educational efforts are needed to raise awareness
of sanitation as being at the nexus of many global challenges.
Developed nations’ outreach agencies including US Agency for
International Development (http://www.usaid.gov/what-we-do/water-
and-sanitation) and Deutsche Gesellschaft für Internationale
Zusammenarbeit (http://www.giz.de/en/ourservices/sustainable_
infrastructure.html) are working to improve sanitation in devel-
oping nations. However, similar efforts to improve upon current
approaches to domestic sanitation appear to be lacking. Effective
age-appropriate and culturally sensitive strategies are required to
raise public consciousness of existing sanitation issues, how exist-
ing and alternative sanitation systems work, and how our behav-
ior and consumption patterns are ultimately linked to sanitation
system influents, the design of sanitation systems, and the prod-
ucts derived from such systems.
Benchmarks and goals, broadening of the research scope, and
educational initiatives may shape and be shaped by a more com-
plete understanding of the major factors opposing or favoring
change in the context of sanitation. It is important to build on
work such as that of Larsen and Lienert (2003) who argue, for
example, that convincing wastewater professionals of the prom-
ise of urine source separation is integral to diffusing this technol-
ogy throughout society. Views of water professionals and other
key stakeholders are likely to be influenced to varying degrees by
water and other resource scarcities, real or perceived additional
costs, and overcoming societal taboos toward discussing sanita-
tion. But drivers and barriers may differ depending upon locally
available resources and stakeholder perspectives as well as the
scale of analysis or application (e.g., household, neighborhood,
village, city) (Jönsson et al. 2010; Meinzinger et al. 2010; Rosemarin
2006).
Acknowledgements
The author is grateful for the work of two anonymous reviewers
whose comments helped focus and streamline the paper, as well
as the contributions of Meaghan Young-Stephens, Clement Loo,
and Andreana Saunders to earlier drafts of this paper.
References
Alloway, B.J., and Jackson, A.P. 1991. The behavior of heavy metals in sewage
sludge-amended soils. Sci. Total Environ. 100: 151–176. doi:10.1016/0048-
9697(91)90377-Q. PMID:2063180.
Anand, C., and Apul, D.S. 2011. Economic and environmental analysis of stan-
dard, high efficiency, rainwater flushed, and composting toilets. J. Environ.
Manage. 92(3): 419–428. doi:10.1016/j.jenvman.2010.08.005. PMID:21056531.
Apan-Idiok, A.U., Udo, I.A., and Braide, E.I. 2012. The use of human urine as an
organic fertilizer in the production of okra (Abelmoschus esculentus) in South
Eastern Nigeria. Resour., Conserv. Recycl. 62: 14–20. doi:10.1016/j.resconrec.
2012.02.003.
Appels, L., Lauwers, J., Degrève, J., Helsen, L., Lievens, B., Willems, K.,
Van Impe, J., and Dewil, R. 2011. Anaerobic digestion in global bio-energy
production: potential and research challenges. Renewable Sustainable En-
ergy Rev. 15(9): 4295–4301. doi:10.1016/j.rser.2011.07.121.
Arora, M., Kiran, B., Rani, S., Rani, A., Kaur, B., and Mittal, N. 2008. Heavy metal
accumulation in vegetables irrigated with water from different sources. Food
Chem. 111: 811–815. doi:10.1016/j.foodchem.2008.04.049.
Ashley, K., Cordell, D., and Mavinic, D. 2011. A brief history of phosphorus: from
the philosopher’s stone to nutrient recovery and reuse. Chemosphere, 84(6):
737–746. doi:10.1016/j.chemosphere.2011.03.001. PMID:21481914.
Austin, L.M., and Cloete, T.E. 2008. Safety aspects of handling and using fecal
material from urine-diversion toilets—a field investigation. Water Environ.
Res. 80(4): 308–315. doi:10.2175/106143007X221021. PMID:18536481.
Published by NRC Research Press
 Pagination not final (cite DOI) / Pagination provisoire (citer le DOI)
Brands
Baird, G.M. 2011. The silver bullet for aging water distribution systems? J. Am.
Water Works Assoc. 103(6): 14–23.
Barles, S. 2007. Feeding the city: food consumption and flow of nitrogen, Paris,
1801–1914. Sci. Total Environ. 375(1–3): 48–58. doi:10.1016/j.scitotenv.2006.12.
003. PMID:17270249.
Basile, T., Petrella, M., Petrella, M., Boghetich, G., Petruzzelli, V., Colasuonno, S.,
and Petruzzelli, D. 2011. Review of endocrine-disrupting-compound removal
technologies in water and wastewater treatment plants: an EU perspective.
Industrial Engineering and Chemical Research, 50(14): 8389–8401. doi:
10.1021/ie101919v.
Beck, B.M. 2013. Why question the prevailing paradigm of wastewater manage-
ment? In Source separation and decentralization for wastewater manage-
ment. Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London,
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
UK. pp. 465–473.
Bengtsson, M., and Tillman, A.-M. 2004. Actors and interpretations in an envi-
ronmental controversy: the Swedish debate on sewage sludge use in agricul-
ture. Resour., Conserv. Recycl. 42(1): 65–82. doi:10.1016/j.resconrec.2004.02.
004.
Bitton, G. 2011. Wastewater Microbiology, 4th Ed. Wiley-Blackwell, Hoboken, NJ.
804 p.
Bixio, D., Thoeye, C., De Koning, J., Joksimovic, D., Savic, D., Wintgens, T., and
Melin, T. 2006. Wastewater reuse in Europe. Desalination, 187(1–3): 89–101.
doi:10.1016/j.desal.2005.04.070.
Boller, M. 2013. Source control and source separation: the Swiss experience.
In Source separation and decentralization for wastewater management.
Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
pp. 439–446.
Boyle, C., Mudd, G., Mihelcic, J.R., Anastas, P., Collins, T., Culligan, P.,
Edwards, M., Gabe, J., Gallagher, P., Handy, S., Kao, J.-J., Krumdieck, S.,
Lyles, L.D., Mason, I., McDowall, R., Pearce, A., Riedy, C., Russell, J.,
Schnoor, J.L., Trotz, M., Venables, R., Zimmerman, J.B., Fuchs, V., Miller, S.,
Page, S., and Breeder-Emery, K. 2010. Delivering sustainable infrastructure
that supports the urban built environment. Environ. Sci. Technol. 44(13):
4836–4840. doi:10.1021/es903749d. PMID:20583825.
Bracken, P., Wachtier, A., Panesar, A.R., and Lange, J. 2006. The road not taken:
For personal use only.
how traditional excreta and greywater management may point the way to a
sustainable future. Water Sci. Technol.: Water Supply, 7(1): 219–227. doi:10.
2166/ws.2007.025.
Brandt, E.M.F., de Queiroz, F.B., Afonso, R.J.C.F., Aquino, S.F., and
Chernicharo, C.A.L. 2013. Behaviour of pharmaceuticals and endocrine
disrupting chemicals in simplified sewage treatment systems. J. Environ.
Manage. 128: 718–726. doi:10.1016/j.jenvman.2013.06.003. PMID:23850766.
Burn, S., Maheepala, S., and Sharma, A. 2012. Utilising integrated urban water
management to assess the viability of decentralised water solutions. Water
Sci. Technol. 66(1): 113–121. doi:10.2166/wst.2012.071. PMID:22678207.
Butler, D., and Davies, J.W. 2011. Urban Drainage. Spon Press, New York, 619 p.
Butler, D., and Parkinson, J. 1997. Towards sustainable urban drainage. Water
Sci. Technol. 35(9): 53–63. doi:10.1016/S0273-1223(97)00184-4.
Chandran, A., Pradhan, S.K., and Heinonen-Tanski, H. 2009. Survival of enteric
bacteria and coliphage MS2 in pure human urine. J. Appl. Microbiol. 107(5):
1651–1657. doi:10.1111/j.1365-2672.2009.04353.x. PMID:19457041.
Chen, J., and Beck, M.B. 1997. Towards designing sustainable urban wastewater
infrastructures: a screening analysis. Water Sci. Technol. 35(9): 99–112. doi:
10.1016/S0273-1223(97)00188-1.
Childers, D.L., Corman, J., Edwards, M., and Elser, J.J. 2011. Sustainability chal-
lenges of phosphorus and food: Solutions from closing the human phos-
phorus cycle. BioScience. 61(2): 117–124. doi:10.1525/bio.2011.61.2.6.
Copeland, C. 2010. Ocean dumping act: a summary of the law. Congressional
Research Service Report 7-5700. Available from http://www.gc.noaa.gov/
documents/gcil_crs_oda.pdf [accessed 5 November 2013].
Cordell, D., Rosemarin, A., Schröder, J.J., and Smit, A.L. 2011. Towards global
phosphorus security: a systems framework for phosphorus recovery and
reuse options. Chemosphere, 84(6): 747–758. doi:10.1016/j.chemosphere.2011.
02.032. PMID:21414650.
Corgiat, C.A., and Templer, D.I. 2003. Relation of attitude toward body elimina-
tion to parenting style and attitude toward the body. Psychological Reports,
92(2): 621–626. doi:10.2466/pr0.2003.92.2.621. PMID:12785652.
Corgiat, M.D., Cappelletty, G.G., Phillips, J., and Templer, D.I. 1986. Body elimi-
nation attitude and vocational interests. J. Clin. Psychol. 42(5): 761–763. doi:
10.1002/1097-4679(198609)42:5<761::AID-JCLP2270420514>3.0.CO;2-T.
Cui, Y., Zhu, Y.-G., Zhai, R., Huang, Y., Qui, Y., and Liang, J. 2005. Exposure to
metal mixtures and human health impacts in a contaminated area in Nan-
ning, China. Environ. Int. 31(6): 784–790. doi:10.1016/j.envint.2005.05.025.
PMID:15979144.
Decrey, L., Udert, K.M., Tilley, E., Pecson, B.M., and Kohn, T. 2011. Fate of the
pathogen indicators phage ⌽X174 and Ascaris suum eggs during the produc-
tion of struvite fertilizer from source-separated urine. Water Res. 45(16):
4960–4972. doi:10.1016/j.watres.2011.06.042. PMID:21807394.
Delleur, J.W. 2003. The evolution of urban hydrology: past, present, and future.
Journal of Hydraulic Engineering, 129(8): 563–573. doi:10.1061/(ASCE)0733-
9429(2003)129:8(563).
Diaz, R.J., and Rosenberg, R. 2008. Spreading dead zones and consequences for
15
marine ecosystems. Science, 321(5891): 926–929. doi:10.1126/science.1156401.
PMID:18703733.
Dolnicar, S., and Schäfer, A.I. 2009. Desalinated versus recycled water: public
perceptions and profiles of the accepters. J. Environ. Manage. 90(2): 888–900.
doi:10.1016/j.jenvman.2008.02.003. PMID:18433981.
Drangert, J.O. 1998. Fighting the urine blindness to provide more sanitation
options. Water SA, 24(2): 157–164. Available from http://www.wrc.org.za/
Knowledge%20Hub%20Documents/Water%20SA%20Journals/Manuscripts/
1998/02/WaterSA_1998_02_apr98_p157.pdf [accessed 6 November 2013].
Ely, L.T., Templer, D.I., Spencer, D.A., and Forward, V.E. 2007. The relationship of
body elimination attitude to value orientation of nursing professionals. Jour-
nal of Social Behavior and Personality, 16(2): 71–77.
Escher, B.I., Pronk, W., Suter, M.J.F., and Maurer, M. 2006. Monitoring the re-
moval efficiency of pharmaceuticals and hormones in different treatment
processes of source-separated urine with bioassays. Environ. Sci. Technol.
40(16): 5095–5101. doi:10.1021/es060598w. PMID:16955913.
Escobar, I.C. 2010. Conclusion: a summary of challenges still facing desalination
and water reuse. In Sustainability Science and Engineering. Vol. 2. (online)
Edited by I.C. Escobar and A.I. Schäfer. Elsevier B.V. pp. 389–397. doi:10.1016/
S1871-2711(09)00214-1.
Esrey, S.A. 2002. Philosophical, ecological and technical challenges for expanding
ecological sanitation into urban areas. Water Sci. Technol. 45(8): 225–228.
PMID:12019825.
Esrey, S., Gough, J., Rapaport, D., Sawyer, R., Simpson-Hébert, M., Vargas, J., and
Winblad, U. 1998. Ecological sanitation. Swedish International Development
Cooperation Agency. Sida S-105-25. Available from http://www.ecosanres.org/
pdf_files/Ecological_Sanitation.pdf [accessed 5 November 2013].
European Commission. 1991. Council Regulation No. 2092-91. On organic
production of agricultural products and indications referring thereto on
agricultural products and foodstuffs. Available from http://eur-lex.europa.eu/
LexUriServ/LexUriServ.do?uri=OJ:L:1991:198:0001:0015:EN:PDF [accessed
5 November 2013].
Eurostat. 2011. Europe in figures – Eurostat yearbook 2011. Available from http://
epp.eurostat.ec.europa.eu/cache/ITY_OFFPUB/KS-CD-11-001/EN/KS-CD-11-001-
EN.PDF [accessed 5 November 2013].
Fam, D.M., and Mitchell, C.A. 2012. Sustainable innovation in wastewater man-
agement: lessons for nutrient recovery and reuse. Local Environment, 17(1):
1–12. doi:10.1080/13549839.2011.627321.
Ferrie, J.P., and Troesken, W. 2008. Water and Chicago’s mortality transition,
1850–1925. Explorations in Economic History, 45(1): 1–16. doi:10.1016/j.eeh.
2007.06.001.
Fittschen, I., and Niemeczynowicz, J. 1997. Experiences with dry sanitation and
greywater treatment in the ecovillage Toarp, Sweden. Water Sci. Technol.
35(9): 161–170. doi:10.1016/S0273-1223(95)00194-8.
Focazio, M.J., Kolpin, D.W., Barnes, K.K., Furlong, E.T., Myer, M.T., Zaugg, S.D.,
Barber, L.B., and Thurman, M.E. 2008. A national reconnaissance for phar-
maceuticals and other organic wastewater contaminants in the United
States — II) Untreated drinking water sources. Sci. Total Environ. 402(2–3):
201–216. doi:10.1016/j.scitotenv.2008.02.021. PMID:18433838.
Foley, J., de Haas, D., Hartley, K., and Lant, P. 2010. Comprehensive life cycle
inventories of alternative wastewater treatment systems. Water Res. 44(5):
1654–1666. doi:10.1016/j.watres.2009.11.031. PMID:20022351.
Friedler, E. 2004. Quality of individual domestic greywater streams and its im-
plications for on-site treatment and reuse possibilities. Environ. Technol.
25(9): 997–1008. doi:10.1080/09593330.2004.9619393. PMID:15515266.
Friedler, E. 2008. The water saving potential and the socio-economic feasibility
of greywater reuse within the urban sector — Israel as a case study. Int. J.
Environ. Stud. 65(1): 57–69. doi:10.1080/00207230701846697.
Friedler, E., Lahav, O., Jizhaki, H., and Lahav, T. 2006. Study of urban population
attitudes towards various wastewater reuse options: Israel as a case study.
J. Environ. Manage. 81(4): 360–370. doi:10.1016/j.jenvman.2005.11.013. PMID:
16574307.
Friedler, E., Butler, D., and Alfiya, Y. 2013. Wastewater composition. In Source
separation and decentralization for wastewater management. Edited by
T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK. pp. 241–257.
Galloway, J.N., Townsend, A.R., Erisman, J.W., Bekunda, M., Cai, Z., Freney, J.R.,
Martinelli, L.A., Seitzinger, S.P., and Sutton, M.A. 2008. Transformation of the
nitrogen cycle: recent trends, questions, and potential solutions. Science,
320(5878): 889–892. doi:10.1126/science.1136674. PMID:18487183.
Ganrot, Z., Borber, J., and Byden, S. 2009. Energy efficient nutrient recovery from
household wastewater using struvite precipitation and zeolite adsorption
techniques: a pilot plant study in Sweden. In International Conference on
Nutrient Recovery from Wastewater Streams. Edited by K. Ashley, D. Mavinic,
and F. Koch. IWA Publishing, London, UK. pp. 511–520.
Gardner, T., and Sharma, A. 2013. Development of decentralized systems in
Australia. In Source separation and decentralization for wastewater manage-
ment. Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London,
UK. pp. 447–454.
Germer, J., Addai, S., and Sauerborn, J. 2011. Response of grain sorghum to
fertilisation with human urine. Field Crops Research, 122(3): 234–241. doi:10.
1016/j.fcr.2011.03.017.
Grant, S.B., Saphores, J.-D., Feldman, D.L., Hamilton, A.J., Fletcher, T.D.,
Cook, P.L.M., Stewardson, M., Sanders, B.F., Levin, L.A., Ambrose, R.F.,
Published by NRC Research Press
 Pagination not final (cite DOI) / Pagination provisoire (citer le DOI)
16
Deletic, A., Brown, R., Jiang, S.C., Rosso, D., Cooper, W.J., and Marusic, I. 2012.
Taking the “waste” out of “wastewater” for human water security and eco-
system sustainability. Science, 337(6095): 681–686. doi:10.1126/science.
1216852. PMID:22879506.
Guest, J.S., Skerlos, S.J., Barnard, J.L., Beck, M.B., Daigger, G.T., Hilger, H.,
Jackson, S.J., Karvazy, K., Kelly, L., Macpherson, L., Mihelcic, J.R.,
Pramanik, A., Raskin, L., Van Loosdrecht, M.C.M., Yeh, D., and Love, N.G.
2009. A new planning and design paradigm to achieve sustainable resource
recovery from wastewater. Environ. Sci. Technol. 43(16): 6126–6130. doi:10.
1021/es9010515. PMID:19746702.
Hanaeus, J., Hellström, D., and Johansson, E. 1997. A study of a urine separation
system in an ecological village in northern Sweden. Water Sci. Technol. 35(9):
153–160. doi:10.1016/S0273-1223(97)00193-5.
Hartley, T.W. 2006. Public perception and participation in water reuse. Desali-
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
nation, 187(1–3): 115–126. doi:10.1016/j.desal.2005.04.072.
Haslam, N. 2012. Psychology in the bathroom. Macmillan Palgrave, New York,
174 p.
Hegger, D., and van Vliet, B. 2010. End user perspectives on the transformation of
sanitary systems. In Social Perspectives on the Sanitation Challenge. Edited by
B. van Vliet, G. Spaargaren, and P. Oosterveer. 2010. Springer Science+Business
Media B. V., New York, pp. 203–216.
Heinonen-Tanski, H., Sjöblom, A., Fabritius, H., and Karinen, P. 2007. Pure hu-
man urine is a good fertiliser for cucumbers. Bioresour. Technol. 98(1): 214–
217. doi:10.1016/j.biortech.2005.11.024. PMID:16413181.
Hellström, D., Baky, A., Jeppsson, U., Jönsson, H., and Kärrman, E. 2008. Com-
parison of environmental effects and resource consumption for different
wastewater and organic waste manage. Systems in a New City area in Swe-
den. Water Res. 80(8): 708–718. doi:10.2175/106143008X276705.
Hendricks, C., Obermosterer, R., Müller, D., Kytzia, S., Baccini, P., and
Brunner, P. 2000. Material flow analysis: a tool to support environmental
policy decision making. Case studies on the city of Vienna and the Swiss
lowlands. Local Environment, 5(3): 311–328. doi:10.1080/13549830050134257.
Höglund, C., Ashbolt, N., Stenstrom, T.A., and Svensson, L. 2002. Viral persis-
tence in source-separated human urine. Advances in Environ. Res. 6(3): 265–
275. doi:10.1016/S1093-0191(01)00057-0.
For personal use only.
Jarvie, H.P., Neal, C., and Withers, P.J.A. 2006. Sewage-effluent phosphorus: a
greater risk to river eutrophication than agricultural phosphorus? Sci. Total
Environ. 360(1–3): 246–253. doi:10.1016/j.scitotenv.2005.08.038.
Jefferson, B., and Jeffrey, P. 2013. Aerobic elimination of organics and pathogens:
greywater treatment. In: Source separation and decentralization for waste-
water management. Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Pub-
lishing, London, UK. pp. 275–289.
Jewitt, S. 2011. Geographies of shit: spatial and temporal variations in attitudes
towards human waste. Progress in Human Geography, 35(5): 608–626. doi:
10.1177/0309132510394704.
Jimenez, B., and Asano, T. 2008. Water reclamation and reuse around the world.
In Water Reuse: An International Survey of current practice, issues, and
needs. Edited by B. Jimenez and T. Asano. IWA Publishing, London, UK.
pp. 3–26.
Jönsson, H., and Vinnerås, B. 2013. Closing the loop: recycling nutrients to agri-
culture. In Source separation and decentralization for wastewater manage-
ment. Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London,
UK. pp. 163–178.
Jönsson, H., Tidåker, P., and Stintzing, A.R. 2010. Role of farmers in improving
the sustainability of sanitation systems. In Social Perspectives on the Sanita-
tion Challenge. Edited by B. van Vliet, G. Spaargaren, and P. Oosterveer. 2010.
Springer Science+Business Media B. V., New York, pp. 179–188.
Kabdaşli, I., Tünay, O., and Udert, K.M. 2013. Transfer into the solid phase.
In: Source separation and decentralization for wastewater management.
Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
pp. 351–365.
Kalavrouziotis, I.K., and Koukoulakis, P.H. 2012. Soil pollution under the effect
of treated municipal wastewater. Environ. Monit. Assess. 184(10): 6297–6305.
doi:10.1007/s10661-011-2420-0. PMID:22083400.
Kampschreur, M.J., Temmink, H., Kleerebezem, R., Jetten, M.S.M., and
van Loosdrecht, M.C.M. 2009. Nitrous oxide emission during wastewater
treatment. Water Res. 43(17): 4093–4103. doi:10.1016/j.watres.2009.03.001.
PMID:19666183.
Kantanoleon, N., Zampetakis, L., and Manios, T. 2007. Public perspectives to-
wards wastewater reuse in a medium size, seaside, Mediterranean city: a
pilot survey. Resour., Conserv. Recycl. 50(3): 282–292. doi:10.1016/j.resconrec.
2006.06.006.
Karak, T., and Bhattacharyya, P. 2011. Human urine as a source of alternative
natural fertilizer in agriculture: a flight of fancy or an achievable reality.
Resour., Conserv. Recycl. 55(4): 400–408. doi:10.1016/j.resconrec.2010.12.008.
Kasprzk-Hordern, B., Dinsdale, R.M., and Guwy, A.J. 2009. The removal of phar-
maceuticals, personal care products, endocrine disruptors and illicit drugs
during wastewater treatment and its impact on the quality of receiving wa-
ters. Water Res. 44(6): 363–380. doi:10.1016/j.watres.2008.10.047.
Kelly, J.J., Häggblom, M., and Tate, R.L. 1999. Effects of the land application of
sewage sludge on soil heavy metal concentrations and soil microbial com-
munities. Soil Biol. Biochem. 31(10): 1467–1470. doi:10.1016/S0038-0717(99)
00060-7.
Environ. Rev. Vol. 22, 2014
Khan, S.J., and Gerrard, L.E. 2006. Stakeholder communications for successful
water reuse operations. Desalination, 187(1–3): 191–202. doi:10.1016/j.desal.
2005.04.079.
Khan, U., and Nicell, J.A. 2010. Assessing the risk of exogenously consumed
pharmaceuticals in land-applied human urine. Water Sci. Technol. 62(6):
1335–1345. doi:10.2166/wst.2010.427. PMID:20861548.
Kirchmann, H., and Pettersson, S. 1995. Human urine — chemical composition
and fertilizer use efficiency. Fertilizer Research, 40(2): 149–154. doi:10.1007/
BF00750100.
Kolpin, D.A., Furlong, E.T., Meyer, M.T., Thurman, E.M., Zaugg, S.D., Barber, L.B.,
and Buxton, H.T. 2002. Pharmaceuticals, hormones, and other organic waste-
water contaminants in US Streams, 1999-2000: a national reconnaissance.
Environ. Sci. Technol. 36(6): 1202–1211. doi:10.1021/es011055j. PMID:11944670.
Kümmerer, K. 2013. The issue of micropollutants in urban water management.
In Source separation and decentralization for wastewater management.
Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
pp. 71–84.
Kutu, F.R., Muchaonyerwa, P., and Mnkeni, P.N.S. 2010. Complementary nutri-
ent effects of separately collected human faeces and urine on the yield and
nutrient uptake of spinach (Spinacia oleracea). Waste Manage. Res. 29(5): 532–
539. doi:10.1177/0734242X10374900.
Lamichhane, K.M., and Babcock, R.W. 2013. Survey of attitudes and perceptions
of urine-diverting toilets and human waste recycling in Hawaii. Sci. Total
Environ. 443: 749–756. doi:10.1016/j.scitotenv.2012.11.039. PMID:23228720.
Langergraber, G., and Muellegger, E. 2005. Ecological sanitation — a way to solve
global sanitation problems? Environ. Int. 31(3): 433–444. doi:10.1016/j.envint.
2004.08.006. PMID:15734195.
LaPara, T.M., Burch, T.R., McNamara, P.J., Tan, D.T., Yan, M., and Eichmiller, J.J.
2011. Tertiary-treated municipal wastewater is a significant point source of
antibiotic resistance genes into Duluth-Superior harbor. Environ. Sci. Tech-
nol. 45(22): 9543–9549. doi:10.1021/es202775r. PMID:21981654.
Larsen, T.A., and Gujer, W. 2013. Implementation of source separation and de-
centralization in cities. In Source separation and decentralization for waste-
water management. Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA
Publishing, London, UK. pp. 135–150.
Larsen, T.A., and Lienert, J. 2003. Societal implications of re-engineering the toilet.
Water Intelligence, March 2003. UNIQUE ID: 200303006. Available from www.
iwaponline.com/wio/2003/03/default001.htm.
Larsen, T.A., Alder, A.C., Eggen, R.I.L., Maurer, M., and Lienert, J. 2009. Source
separation: will we see a paradigm shift in wastewater handling? Environ.
Sci. Technol. 43(16): 6121–6125. doi:10.1021/es803001r. PMID:19746701.
Larsen, T.A., Udert, K., and Lienert, J. 2013. Source separation and decentraliza-
tion for wastewater management. IWA Publishing, London, UK. 520 p.
Leal, L.H., Vieno, N., Temmink, H., Zeeman, G., and Buishman, C.J.N. 2010.
Occurrence of xenobiotics in gray water and removal in three biological
treatment systems. Environ. Sci. Technol. 44(17): 6835–6842. doi:10.1021/
es101509e. PMID:20681737.
Lens, P., Zeeman, G., and Lettinga, G. 2001. Decentralised sanitation and reuse:
concepts, systems and implementation. IWA Publishing, London, UK. 650 p.
Leslie, G., and Bradford-Hartke, Z. 2013. Membrane processes. In Source separa-
tion and decentralization for wastewater management. Edited by T.A. Larsen,
K. Udert, and J. Lienert. IWA Publishing, London, UK. pp. 367–381.
Levine, A.D., and Asano, T. 2004. Recovering sustainable water from wastewater.
Environ. Sci. Technol. 38(11): 201A–208A. doi:10.1021/es040504n. PMID:15224722.
Lewis, D.L., and Gattie, D.K. 2002. Pathogen risks from applying sewage sludge to
land. Environ. Sci. Technol. 36(13): 286A–293A. doi:10.1021/es0223426. PMID:
12144261.
Lienert, J., and Larsen, T.A. 2010. High acceptance of urine source separation in
seven european countries: a review. Environ. Sci. Technol. 44(2): 556–566.
doi:10.1021/es9028765. PMID:20000706.
Lienert, J., Monstadt, J., and Truffer, B. 2006. Future scenarios for a sustainable
water sector: a case study from Switzerland. Environ. Sci. Technol. 40(2):
436–442. doi:10.1021/es0514139. PMID:16468386.
Lienert, J., Koller, M., Konrad, J., Mcardell, C.S., and Schuwirth, N. 2011. Multiple-
criteria decision analysis reveals high stakeholder preference to remove
pharmaceuticals from hospital wastewater. Environ. Sci. Technol. 45(9):
3848–3857. doi:10.1021/es1031294. PMID:21417333.
Listowski, A., Ngo, H.H., Guo, W.S., Vigneswaran, S., Shin, H.S., and Moon, H.
2011. Greenhouse gas (ghg) emissions from urban wastewater system: future
assessment framework and methodology. Journal of Water Sustainability,
1(1): 113–125. Available from http://www.jwsponline.com/uploadpic/Magazine/
2011110209131249918220.pdf [accessed 5 November 2013].
Liu, Z., Zhao, Q., Wang, K., Lee, D., Qui, W., and Wang, J. 2008. Urea hydrolysis
and recovery of nitrogen and phosphorus as MAP from stale human urine.
J. Environ. Sci. (Beijing, China), 20(8): 1018–1024. doi:10.1016/S1001-0742(08)
62202-0.
Liu, Z., Kanjo, Y., and Mizutani, S. 2009. Urinary excretion rates of natural
estrogens and androgens from humans, and their occurrence and fate in the
environment: a review. Sci. Total Environ. 407(18): 4975–4985. doi:10.1016/j.
scitotenv.2009.06.001. PMID:19559467.
Londong, J. 2013. Practical experience with source separation in Germany.
In Source separation and decentralization for wastewater management.
Published by NRC Research Press
 Pagination not final (cite DOI) / Pagination provisoire (citer le DOI)
Brands
Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
pp. 423–430.
Magid, J., Eilersen, A.M., Wrisberg, S., and Henze, M. 2006. Possibilities and
barriers for recirculation of nutrients and organic matter from urban to
rural areas: a technical theoretical framework applied to the medium-
sized town Hillerød, Denmark. Ecological Engineering, 28(1): 44–54. doi:10.
1016/j.ecoleng.2006.03.009.
Maimon, A., Tal, A., Friedler, E., and Gross, A. 2010. Safe on-site reuse of greywa-
ter for irrigation — a critical review of current guidelines. Environ. Sci.
Technol. 44(9): 3213–3220. doi:10.1021/es902646g. PMID:20380412.
Maurer, M. 2013. Full costs, (dis-)economies of scale and the price of uncertainty.
In Source separation and decentralization for wastewater management.
Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
pp. 85–100.
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
Maurer, M., Rothenberger, D., and Larsen, T.A. 2006. Decentralised wastewater
treatment technologies from a national perspective: at what cost are they
competitive? Water Sci. Technol.: Water Supply, 5(6): 145–154.
McCarty, P., Bae, J., and Kim, J. 2011. Domestic wastewater treatment as a net
energy producer — can this be achieved? Environ. Sci. Technol. 45(17): 7100–
7106. doi:10.1021/es2014264. PMID:21749111.
Meinzinger, F., Ziedorn, V., and Peters, I. 2010. Interactions between urban
forms and source-separating sanitation technologies. In Social Perspectives
on the Sanitation Challenge. Edited by B. van Vliet, G. Spaargaren, and
P. Oosterveer. 2010. Springer Science+Business Media B.V., New York,
pp. 125–144.
Melosi, M. 2008. The sanitary city: environmental services in urban America
from colonial times to the present. University of Pittsburgh Press, Pittsburgh,
PA. 400 p.
Milbrandt, A. 2005. A geographic perspective on the current biomass resource
availability in the United States. National Renewable Energy Laboratory
Technical Report NREL/TP-560-39181. Available from http://www.afdc.energy.
gov/pdfs/39181.pdf [accessed 5 November 2013].
Mitchell, V.G. 2006. Applying integrated urban water management concepts: a
review of australian experience. Environmental Management, 37(5): 589–
605. doi:10.1007/s00267-004-0252-1. PMID:16508805.
Mnkeni, P.N.S., and Austin, L.M. 2009. Fertiliser value of human manure from
For personal use only.
pilot urine-diversion toilets. Water SA, 35(1): 133–138. Available from http://
www.ajol.info/index.php/wsa/article/view/76717 [accessed 6 November 2013].
Mulder, A. 2003. The quest for sustainable nitrogen removal technologies. Wa-
ter Sci. Technol. 48(1): 67–75. PMID:12926622.
Nakagawa, N., Kwamura, A., and Amaguchi, H. 2012. Energy and cost benefit
evaluation of a urine diversion system — a case study at highway service
areas in Japan. In ASCE World Environmental and Water Resource Congress
2012: Crossing Boundaries. Edited by E.D. Loucks. pp. 2795–2802.
National Research Council. 2002. Biosolids applied to land: advancing standards
and practices. National Academies Press. Washington, D.C. 346 p. Available
from http://www.nap.edu/openbook.php?isbn=0309084865 [accessed 5 No-
vember 2013].
National Research Council. 2012. Water reuse: potential for expanding the na-
tion’s water supply through reuse of municipal wastewater. National Acad-
emies Press. Washington, D.C. 276p. Available from http://www.nap.edu/
openbook.php?record_id=13303&page=R1 [accessed 5 November 2013].
Neset, T.-S.S., Drangert, J.-O., Bader, H.-P., and Scheidegger, R. 2010. Recycling of
phosphorus in urban Sweden: a historical overview to guide a strategy for the
future. Water Policy, 12: 611–624. doi:10.2166/wp.2009.165.
New York Department of Environmental Conservation. 2013. Combined
sewer overflow. Available from http://www.dec.ny.gov/chemical/48595.html
[accessed November 5, 2013].
Newman, P.W.G. 1999. Sustainability and cities: extending the metabolism
model. Landscape and Urban Planning. 44(4): 219–226. doi:10.1016/S0169-
2046(99)00009-2.
Nichols, C.E. 2004. Overview of anaerobic digestion technologies in Europe.
BioCycle, 45(1): 47–53.
Nielsen, J.B.H., Al Seadi, T., and Oleskowicz-Popiel, P. 2009. The future of anaer-
obic digestion and biogas utilization. Bioresour. Technol. 100(22): 5478–
5484. doi:10.1016/j.biortech.2008.12.046. PMID:19217772.
Nordin, A., Nyberg, K., and Vinneras, B. 2009. Inactivation of Ascaris eggs in
source-separated urine and feces by ammonia at ambient temperatures.
Appl. Environ. Microbiol. 75(3): 662–667. doi:10.1128/AEM.01250-08. PMID:
19060175.
Orumwense, P.O., Torvinen, E., and Heinonen-Tanski, H. 2013. The survival of
mycobacteria in pure human urine. Water Sci. Technol. 67(8): 1773–1777.
doi:10.2166/wst.2013.052. PMID:23579832.
Otterpohl, R., and Buzie, C. 2013. Treatment of the solid fraction. In Source
separation and decentralization for wastewater management. Edited by
T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
pp. 259–273.
Otterpohl, R., Grottker, M., and Lange, J. 1997. Sustainable water and waste
manage in urban areas. Water Sci. Technol. 35(9): 121–133. doi:10.1016/S0273-
1223(97)00190-X.
Pachepsky, Y., Shelton, D.R., McLain, J.E.T., Patel, J., and Mandrell, R.E. 2011.
Irrigation waters as a source of pathogenic microorganisms in produce: a
review. In Advances in Agronomy. Vol 113. Edited by D.L. Sparks. Elsevier Press,
17
Amsterdam, the Netherlands. pp. 73–138. doi:10.1016/B978-0-12-386473-4.
00007-5.
Pearson, N.S., Mnkeni, F.R., Kutu, P.M., and Austin, L.M. 2008. Evaluation for
human urine as a source of nutrients for selected vegetables and maize under
tunnel house conditions in the Eastern Cape, South Africa. Waste Manage.
Res. 26(2): 132–139. doi:10.1177/0734242X07079179.
Pradhan, S.K., Nerg, A.-M., Sjöblom, A., Holopainen, J.K., and Heinonen-Tanski, H.
2007. Use of human urine fertilizer in cultivation of cabbage (Brassica oleracea)
— impacts on chemical, microbial, and flavor quality. J. Agric. Food Chem.
55(21): 8657–8663. doi:10.1021/jf0717891. PMID:17894454.
Pradhan, S.K., Holopainen, J.K., Weisell, J., and Heinonen-Tanski, H. 2010.
Human urine and wood ash as plant nutrients for red beet (Beta vulgaris)
cultivation: impacts on yield quality. J. Agric. Food Chem. 58(3): 2034–2039.
doi:10.1021/jf9029157. PMID:20050665.
Proença, L.C., Ghisi, E., Tavares, D.F., and Coelho, M. 2011. Potential for electric-
ity savings by reducing potable water consumption in a city scale. Resour.
Conserv. Recycl. 55(11): 960–965. doi:10.1016/j. resconrec.2011.05.003.
Rabalais, N.N., Turner, R.E., and Wiseman, W.J. 2002, Gulf of Mexico hypoxia,
aka “The dead zone”. Annual Review of Ecology and Systematics, 33: 235–
263. doi:10.1146/annurev.ecolsys.33.010802.150513.
Radjenović, J., Petrović, M., and Barceló, D. 2009. Fate and distribution of phar-
maceuticals in wastewater and sewage sludge of the conventional activated
sludge (CAS) and advanced membrane bioreactor (MBR) treatment. Water
Res. 43(3): 831–841. doi:10.1016/j.watres.2008.11.043. PMID:19091371.
Remy, C., and Jekel, M. 2008. Sustainable wastewater management: life cycle
assessment of conventional and source-separating urban sanitation systems.
Water Sci. Technol. 58(8): 155–1532. doi:10.2166/wst/2008.533.
Renzetti, S., and Kushner, J. 2004. Full cost accounting for water supply and
sewage treatment: concepts and case application. Canadian Water Res. J.
29(1): 13–22. Available from http://www.tandfonline.com/doi/pdf/10.4296/
cwrj13 [accessed 5 November 2013]. 10.4296/cwrj13.
Rittman, B.E. 2013. The energy issue in urban water management. In Source
separation and decentralization for wastewater management. Edited by
T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK. pp. 13–27.
Robertson, D.M., and Saad, D.A. 2011. Nutrient inputs to the Laurentian Great
Lakes by source and watershed estimated using SPARROW watershed mod-
els. J. Am. Water Res. Assoc. 47(5): 1011–1033. doi:10.1111/j.1752-1688.2011.
00574.x. PMID:22457580.
Robinson, K.G., Robinson, C.H., and Hawkins, S.A. 2005. Assessment of public
perception regarding wastewater reuse. Water Sci. Technol.: Water Supply,
5(1): 59–65.
Rockström, J., Steffen, W., Noone, K., Persson, Å., Chapin, F.S., Lambin, E.F.,
Lenton, T.M., Scheffer, M., Folke, C., Schnellnhuber, H.J., Nykvist, B.Z.,
de Wit, C.A., Hughes, T., van der Leeuw, S., Rodhe, H., Sörlin, S., Snyder, P.K.,
Costanza, R., Svedin, U., Falkenmark, M., Karlberg, L., Corell, R.W.,
Fabry, V.J., Hansen, J., Walker, B., Liverman, D., Richardson, K., Crutzen, P.,
and Foley, J.A. 2009. A safe operating space for humanity. Nature, 461(7263):
472–475. doi:10.1038/461472a. PMID:19779433.
Ronteltap, M., Maurer, M., and Gujer, W. 2007. The behaviour of pharmaceuti-
cals and heavy metals during struvite precipitation in urine. Water Res. 41(9):
1859–1868. doi:10.1016/j.watres.2007.01.026. PMID:17368503.
Rosemarin, A. 2006. Sustainable sanitation and water in small urban centres.
Water Sci. Technol. 51(8): 109–118. PMID:16007935.
Rosenquist, L.E.D. 2005. A psychosocial analysis of the human-sanitation nexus.
Journal of Environmental Psychology, 25(3): 335–346. doi:10.1016/j.jenvp.
2005.07.003.
Rozin, P., Haidt, J., and McCauley, C.R. 2008. Disgust. In Handbook of Emotions.
3rd Edition. Edited by M. Lewis, J.M. Haviland-Jones, and L.F. Barrett. The
Guilford Press, New York, pp. 757–776.
Saeck, E.A., O’Brien, K.R., Weber, T.R., and Burford, M.A. 2013. Changes to
chronic nitrogen loading from sewage discharges modify standing stocks of
coastal phytoplankton. Mar. Pollut. Bull. 71(1–2): 159–167. doi:10.1016/j.mar
polbul.2013.03.020. PMID:23632088.
Sahely, H.R., Dudding, S., and Kennedy, C.A. 2003. Estimating the urban metab-
olism of Canadian cities: Greater Toronto area case study. Can. J. Civ. Eng.
30(2): 468–483. doi:10.1139/l02-105.
Schosseler, P., Lohmann, T., Schmitt, B., Perbal, S., Dubois, C., Sauerborn, K.,
Muschwitz, C., and Weidenhaupt, A. 2007. Implementing sustainable sanita-
tion concepts in Luxembourg: methodological approach and outcomes.
Water Sci. Technol. 56(5): 33–41. doi:10.2166/wst.2007.554. PMID:17881835.
Schwarzenbach, R.P., Egli, T., Hofstetter, T.B., von Gunten, U., and Wehrli, B.
2010. Global water pollution and human health. Annual Reviews of Envi-
ronment and Resources, 35: 109–136. doi:10.1146/annurev-environ-100809-
125342.
Shrestha, D., Srivastava, A., Shakya, S.M., Khadka, J., and Acharya, B.S. 2013. Use
of compost supplemented human urine in sweet pepper (Capsicum annum L.)
production. Sci. Hortic. 153: 8–12. doi:10.1016/j.scienta.2013.01.022.
Stark, K. 2004. Phosphorus recovery — experience from European countries. In
Proceedings of Polish-Swedish seminars. Integration and optimization of urban
sanitation systems. Edited by E. Plaza, E. Levlin, and B. Hultman. Stockholm, SE.
pp. 19 –30. Available from http://www2.lwr.kth.se/forskningsprojekt/
Polishproject/rep12/StarkSthlm19.pdf [accessed 6 November 2013].
Published by NRC Research Press
 Pagination not final (cite DOI) / Pagination provisoire (citer le DOI)
18
Stenström, T.A. 2013. Hygiene, a major challenge for source separation and
decentralization. In Source separation and decentralization for wastewater
management. Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing,
London, UK. pp. 151–161.
Sterrit, R.M., and Lester, J.N. 1980. The value of sewage sludge to agriculture and
effects of the agricultural use of sludges contaminated with toxic elements: A
review. Sci. Total Environ. 16(1): 55–90. doi:10.1016/0048-9697(80)90102-3.
PMID:7433970.
Stevenson, R., and Repacholi, B. 2005. Does the source of an interpersonal odour
affect disgust? A disease risk model and its alternatives. European Journal of
Social Psychology, 35: 375–401. doi:10.1002/ejsp.263.
Swart, D., and Palsma A.J. 2013. The Netherlands: “Nieuwe Sanitatie.” In Source
separation and decentralization for wastewater management. Edited by
T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
Environ. Rev. Downloaded from nrcresearchpress.com by UNIV OF MINNESOTA AT MORRIS on 05/21/14
pp. 431–438.
Tchobanoglous, G., and Leverenz, H. 2013. The rationale for decentralization of
wastewater infrastructure. In Source separation and decentralization for
wastewater management. Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA
Publishing, London, UK. pp. 101–115.
Tchobanoglous, G., Burton, F.L., and Stensel, D.H. 2003. Wastewater engineer-
ing, treatment, and reuse. McGraw-Hill, New York, 1819 p.
Templer, D.I., King, F.L., Brooner, R.K., and Corgiat, M. 1984. Assessment of body
elimination attitude. J. Clin. Psychol. 40(3): 754–759. doi:10.1002/1097-4679
(198405)40:3<754::AID-JCLP2270400321>3.0.CO;2-M. PMID:6746985.
Ternes, T.A., Joss, A., and Siegrist, H. 2004. Scrutinizing pharmaceuticals and
personal care products in wastewater treatment. Environ. Sci. Technol.
38(20): 392A–399A. doi:10.1021/es040639t. PMID:15543724.
Thibodeau, C., Monette, F., Glaus, M., and Laflamme, C.B. 2011. Economic viabil-
ity and critical influencing factors assessment of black water and grey water
source-separation sanitation system. Water Sci. Technol. 64(12): 2417–2424.
doi:10.2166/wst. 2011.796. PMID:22170836.
Tidaker, P., Mattsson, B., and Jönsson, H. 2007. Environmental impact of wheat
production using human urine and mineral fertilisers — a scenario study.
J. Cleaner Prod. 15(1): 52–62. doi:10.1016/j.jclepro.2005.04.019.
Tilley, E. 2013. Conceptualizing sanitation systems to account for new complex-
ities in processing and management. In Source separation and decentraliza-
For personal use only.
tion for wastewater management. Edited by T.A. Larsen, K. Udert, and
J. Lienert. IWA Publishing, London, UK. pp. 227–239.
Toze, S. 2006. Reuse of effluent water — benefits and risks. Agricultural Water
Management, 80: 147–159. doi:10.1016/j.agwat.2005.07.010.
Travis, M.J., Wiel-Shafran, A., Weisbrod, N., Adar, E., and Gross, A. 2010. Grey-
water reuse for irrigation: effect on soil properties. Sci. Total Environ.
408(12): 2501–2508. doi:10.1016/j.scitotenv.2010.03.005. PMID:20350744.
Truffer, B., Binz, C., Gebauer, H., and Störmer, E. 2013. Market success of on-site
treatment: a systemic innovation problem. In Source separation and decen-
tralization for wastewater management. Edited by T.A. Larsen, K. Udert, and
J. Lienert. IWA Publishing, London, UK. pp. 209–223.
Udert, K.M., and Jenni, S. 2013. Biological nitrogen conversion processes.
In Source separation and decentralization for wastewater management.
Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
pp. 291–305.
US Census Bureau. 2013. International programs: international data base. Avail-
able from http://www.census.gov/population/international/data/idb/
informationGateway.php [accessed 6 November 2013].
US EPA. 2004a. Primer for municipal wastewater treatment systems. EPA office
of wastewater management. EPA-832-R-04-0001. Available from http://
water.epa.gov/aboutow/owm/upload/2005_08_19_primer.pdf. [accessed
6 November 2013].
US EPA. 2004b. Guidelines for water reuse. EPA municipal support division,
office of wastewater management. EPA/625/R-04/108. Available from http://
water.epa.gov/aboutow/owm/upload/Water-Reuse-Guidelines-625r04108.pdf
[accessed 6 November 2013].
US EPA. 2006. Wastewater management fact sheet, energy conservation. EPA
832-F-06-024. Available from http://water.epa.gov/scitech/wastetech/upload/
2008_01_16_mtb_energycon_fasht_final.pdf [accessed 6 November 2013].
US EPA. 2007. Opportunities for and benefits of combined heat and power at
wastewater treatment facilities. EPA-430-R-07-003. Available from http://
water.epa.gov/infrastructure/sustain/upload/2009_5_13_wwtf_opportunities.
pdf [accessed 6 November 2013].
US EPA. 2008. Clean watersheds needs survey-report to Congress. EPA-832-R-10-
002. Available from http://water.epa.gov/scitech/datait/databases/cwns/
upload/cwns2008rtc.pdf [accessed 6 November 2013].
US EPA. 2010a. State of technology for rehabilitation of wastewater collection
systems. EPA/600/R-10/078. Available from http://nepis.epa.gov/Adobe/PDF/
P1008C45.pdf [accessed 6 November 2013].
View publication stats
Environ. Rev. Vol. 22, 2014
US EPA. 2010b. Evaluation of energy conservation measures for wastewater treat-
ment facilities. EPA-832-R-10-005. Available from http://water.epa.gov/
scitech/wastetech/upload/Evaluation-of-Energy-Conservation-Measures-for-
Wastewater-Treatment-Facilities.pdf [accessed 6 November 2013].
US EPA. 2012. Water: sewage sludge (biosolids) frequently asked questions. Avail-
able from http://water.epa.gov/polwaste/wastewater/treatment/biosolids/
genqa.cfm [accessed 6 November 2013].
van Vliet, B., and Spaargaren, G. 2010. Sense and sanitation. In Social Perspec-
tives on the Sanitation Challenge. Edited by B. van Vliet, G. Spaargaren, and
P. Oosterveer. 2010. Springer Science+Business Media B.V., New York, pp. 31–47.
van Vliet, B., Spaargaren, G., and Oosterveer, P. 2011. Sanitation under challenge:
contributions from the social sciences. Water Policy, 13(6): 797–809. doi:10.
2166/wp.2011.089.
van Vliet, W. 1996. Sustainable development, global restructuring and immi-
grant housing. Habitat International, 20(3): 349–358. doi:10.1016.0197-3975
(96)00018-5.
van Vurren, D.P., Bouwman, A.F., and Beusen, A.H.W. 2010. Phosphorus demand
for the 1970–2100 period: a scenario analysis of resource depletion. Global
Environmental Change, 20(3): 428–439. doi:10.1016/j.gloenvcha.2010.04.004.
Varis, O., and Somlyódy, L. 1997. Global urbanization and urban water: can
sustainability be afforded? Water Sci. Technol. 35(9): 21–32. doi:10.1016/
S0273-1223(97)00181-9.
Vinnerås, B., and Jönsson, H. 2013. The Swedish experience with source separa-
tion. In Source separation and decentralization for wastewater management.
Edited by T.A. Larsen, K. Udert, and J. Lienert. IWA Publishing, London, UK.
pp. 415–422.
Vinnerås, B., Nordin, A., Niwagaba, C.B., and Nyberg, K. 2008. Inactivation of
bacteria and viruses in human urine depending on temperature and dilution
rate. Water Res. 42(15): 4067–4074. doi:10.1016/j.watres.2008.06.014. PMID:
18718625.
Wang, H., Brow, S.L., Magesan, G.N., Slade, A.H., Quiern, M., Clinton, P.W., and
Payn, T.W. 2008. Technological options for the management of biosolids.
Environ. Sci. Pollut. Res. 15(4): 308–317. doi:10.1007/s11356-008-0012-5.
Wang, L., Peng, J., Wang, B., and Yang, L. 2006. Design and operation of an
eco-system for municipal wastewater treatment and utilization. Water Sci.
Technol. 54(11–12): 429–436. doi:10.2166/wst.2006.923. PMID:17302348.
Warren-Rhodes, K., and Koenig, A. 2001. Escalating trends in the urban metab-
olism of Hong Kong: 1971–1997. Ambio, 30(7): 429–438. doi:10.1579/0044-
7447-30.7.429.
Water Environ. Res. Foundation. 2011. Nutrient recovery: state of the knowledge
as of December 2010. Available from www.werf.org/c/2011Challenges/
Nutrient_Recovery.aspx [accessed 6 November 2013].
Werner, C., Panesar, A., Rud, S.B., and Olt, C.U. 2009. Ecological sanitation:
principles, technologies and project examples for sustainable wastewater
and excreta management. Desalination, 248(1–3): 392–401. doi:10.1016/j.desal.
2008.05.080.
Wilsenach, J.A., Schuurbiers, C.A.H., and van Loosdrecht, M.C.M. 2007. Phos-
phate and potassium recovery from source separated urine through struvite
precipitation. Water Res. 41(2): 458–466. doi:10.1016/j.watres.2006.10.014.
PMID:17126877.
Winker, M., Vinnerås, B., Muskolus, A., Arnold, U., and Clemens, J. 2009. Fertil-
iser products from new sanitation systems: their potential values and risks.
Bioresour. Technol. 100(18): 4090–4096. doi:10.1016/j.biortech.2009.03.024.
PMID:19375910.
Winker, M., Clemens, J., Reich, M., Gulyas, H., and Otterpohl, R. 2010. Ryegrass
uptake of carbamazepine and ibuprofen applied by urine fertilization. Sci.
Total Environ. 408(8): 1902–1908. doi:10.1016/j.scitotenv.2010.01.028. PMID:
20153514.
Wolman, A. 1965. The metabolism of cities. Sci. Am. 213(3): 179–190. doi:10.1038/
scientificamerican0965-178. PMID:14338520.
Writer, J.H., Ferrer, I., Barber, L.B., and Thurman, E.M. 2013. Widespread occur-
rence of neuro-active pharmaceuticals and metabolites in 24 Minnesota riv-
ers and wastewaters. Sci. Total Environ. 461– 462: 519–527. doi:10.1016/j.
scitotenv.2013.04.099. PMID:23751335.
Xu, M., Crittenden, J.C., Chen, Y., Thomas, V.M., Noonan, D.S., Desroches, R.,
Brown, M.A., and French, S.P. 2010. Gigaton problems need gigaton solu-
tions. Environ. Sci. Technol. 44(11): 4037–4041. doi:10.1021/es903306e.
PMID:20462269.
Yusuf, R.O., Noor, Z.Z., Abba, A.H., Abu Hassan, M.A., and Mohd Din, M.F. 2012.
Methane emission by sectors: a comprehensive review of emission sources
and mitigation methods. Renewable Sustainable Energy Rev. 16(7): 5059–
5070. doi:10.1016/j.rser.2012.04.008.
Published by NRC Research Press