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Abstract: Public health risk from on-site wastewater treatment systems has not been easy to quantify. An ecological study was undertaken to identify where the potential for public health risk is highest from the use of on-site wastewater treatment systems by examining each of the 88 counties in Ohio. Using the county as the unit of analysis, public records were accessed and data were collected and analyzed on several characteristics of the 88 counties in Ohio. Maps were developed to begin identifying areas of the state that may be at a higher risk for GI illness occurrence. Using poisson regression, unadjusted and adjusted incidence rate ratios were calculated for the proportion of rural housing units, the proportion of housing units built before 1970, the proportion of housing units with septic systems, the proportion of housing units with wells, region 1 housing units built after 1970, region 2 housing units built after 1970, region 4 housing units built after 1970, and region 5 housing units built after 1970 to help quantify GI risk from on-site wastewater systems. The calculated adjusted IRR''s for most of these variables were below 1.000 indicating a protective effect in their impact on GI rate in Ohio except for the proportion of rural housing units and the proportion of housing units built before 1970 [1.305 (1.195 - 1.425) and 1.282 (1.231 - 1.335) respectively]. Along with the other data gathered and examined, there does appear to be an argument for further study being done in order to better quantify this issue.