Unsafe to Drink, Unfit to Flush: A Look at America’s Forgotten Infrastructure
From unsafe private wells, to failing sanitation systems... millions of Americans still living without clean water or indoor plumbing.
Unsafe Drinking Water in U.S. Areas, Private Wells, and Outdoor Sanitation: A Comprehensive Report
By Wilbur Brower
Introduction
Access to safe drinking water and sanitation remains a critical public health concern in the United States. While many Americans benefit from regulated municipal water systems, numerous towns, cities, rural areas, and mobile home parks still face contamination threats from lead, PFAS (“forever chemicals”), agricultural runoff, and aging infrastructure. Approximately 15 percent of U.S. residents—over 43 million people—depend on private wells, which are not covered by federal drinking water standards. Studies indicate that around 20–25 percent of private wells contain contaminants at levels posing health risks. Meanwhile, national data on outdoor sanitation (e.g. open defecation or informal toilets) is extremely limited in the U.S.; anecdotal reports suggest only small, under-served communities lack modern indoor plumbing.
This report presents state-level summaries, where documented national data on well usage and contaminant exposure, plus discussion of outdoor sanitation. It concludes with recommendations and references in MLA style.
Part I: Drinking Water Safety by Areas
Examples of Contaminated Locations
Flint, Michigan: Lead crisis affected thousands; as of 2024, ~2,500 lead service lines remained, with replacement ongoing arXiv+2Wikipedia+2arXiv+2.
Buffalo, New York: Over half of service lines contain lead; 6 percent of children have elevated lead blood levels—three times Flint's rate NRDC.
Jackson, Mississippi: Repeated boil alerts, >7,300 water main breaks since 2018; many residents avoid tap water entirely Wikipedia.
Crestwood, Illinois: Private wells contaminated for decades, residents notified only in 2008 despite long exposure PMC+6Wikipedia+6Multipure+6.
Eastern Coachella Valley, California: Farmworker communities face arsenic and other contaminants; lack trust and spend up to 10 percent of income on bottled water PMC+4AP News+4GQ+4.
Martin County, Kentucky: 2000 coal-slurry spill contaminated aquifer; now only ~12 percent use tap water; infrastructure leaking ~70 percent of supply Wikipedia.
Mobile Home Parks (many states): Nearly 70 percent that operate private systems violate federal water standards; common in Michigan, Utah, Colorado, others AP News+1AP News+1.
Part II: Private Well–Water Use & Contamination
State/Nationwide
Estimated Population Using Wells
Estimated % of Those Wells Contaminated
United States
~43 million (≈15 % of population) US EPA
~20–25 % have contaminants above safe benchmarks USGSKFF Health News
State-level breakdown is not comprehensively available from federal sources. Private well reliance varies by rurality; states with large rural populations (e.g. Iowa, North Carolina, Kentucky) likely exceed the national average. The EPA's private well map tool offers block-level data but not easily tabulated state aggregates.
A recent USGS/EPA study found PFAS contamination affecting up to 27 percent of Americans (~95 million people) using groundwater–based wells—mixing hospital and municipal samples—including high risk in Michigan, Florida, North Carolina, Pennsylvania, New York, Ohio US EPAThe Guardian. By mid-2025, nearly 165 million Americans were served by water systems with detectable PFAS levels EWG.
Part III: Outdoor Toilets / Open Defecation in U.S.
There is no reliable nationwide data by state on Americans using outdoor toilets in the sense of lacking indoor plumbing.
A minority of extremely under-served or marginalized rural communities and mobile home park residents may rely on unsanitary systems or straight-piped sanitation Atlas & BootsarXiv.
Globally, ~419 million people practice open defecation—but that figure is outside the U.S. context PSCI+2Statista+2PMC+2.
In the U.S., it’s estimated more than two million people lack running water or full indoor plumbing, disproportionately affecting Native American, African-American, and Latinx households GQ.
Rural Water and Sanitation in Economically Depressed U.S. States
Key Case Studies
Lowndes County, Alabama
In rural majority-Black Lowndes County, 60–80% of rural households lack functioning sanitation systems, relying on informal “straight-piped” waste disposal that contaminates yards and poses serious health risks (parasite exposure, hookworm) The Guardian+1arXiv+1.
A 2023 civil-rights settlement funding septic installation was reversed in April 2025, halting remediation efforts and exposing residents to renewed health hazards The Guardian.
Mississippi Delta (Shaw, MS & Surrounding)
In the Mississippi Delta region, poor infrastructure correlates with elevated rates of intestinal parasitic infections—38% of children tested positive, 80% exhibited inflammation—linked to contaminated water and failing sanitation systems The Guardian.
Martin County, Kentucky
Martin County suffered a massive coal-slurry spill in 2000 contaminating local water with arsenic and coliform bacteria.
A 2018 study found 47% of household samples had at least one contaminant; only 12% of surveyed residents drank tap water, preferring bottled or boiled water Wikipedia+5Wikipedia+5AP News+5.
Infrastructure failures remain common; outages and breaks are frequent and costly.
Jackson, Mississippi
The capital city suffers ongoing lead contamination, frequent boil-water advisories (300+ since 2018), and over 7,300 main breaks, resulting in residents avoiding tap water entirely and reliance on bottled water Wikipedia+2AP News+2Reddit+2Wikipedia+1Reddit+1.
Oklahoma (Alfalfa County and Stilwell)
Oklahoma has limited state-level well-water regulation. Only ~15% of private well owners routinely test their water; in one pilot, 20% of sampled rural wells in Alfalfa County tested positive for bacteria including E. coli PMC+1Reddit+1.
Stilwell, OK, is an economically depressed town with possible aquifer contamination by mercury and elevated mortality; its water supplies remain under scrutiny https://www.azfamily.com+15Wikipedia+15The Guardian+15.
Mobile Home Park Residents (Nation-wide, incl. Utah & Colorado)
Nearly 70% of mobile home parks that manage their own water supplies violated federal standards in the past five years—higher than municipal systems USGS+2AP News+2AP News+2.
Utah and Colorado have begun robust oversight: Utah monitors all parks, and Colorado mandates universal water testing at park level AP News+1AP News+1.
Eastern Coachella Valley, California
Farmworker and low-income communities face arsenic and other contaminants in well water and serious distrust of tap water. Many spend up to 10% of income on bottled water AP News.
Water quality issues persist despite state and federal efforts.
Survey Data on Private Well Use & Sanitation (Approximate State-Level Context)
While precise numeric breakdowns by state are rarely published, the following table organizes available qualitative and approximate data:
State/Region
Private Well Use & Water Safety
Sanitation & Indoor Plumbing Status
Alabama (Lowndes Co.)
Many rely on rural wells; monitoring low; high contamination exposure risk
60–80% rural households without sanitation system; extensive straight-pipe use The Guardian+3The Guardian+3TIME+3
Mississippi Delta
Rural wells common; water quality poorly maintained
Parasitic infection rates high; likely widespread sanitation failures The Guardian
Kentucky (Martin Co.)
Well/tap water infrastructure is heavily contaminated; most residents avoid using tap water
Many homes lack adequate indoor plumbing; affordability crisis prevents sanitation upgrades Wikipedia
Oklahoma (rural Alfalfa Co.)
~20% of tested wells contaminated; overall low testing compliance (~15%)
Rural areas with minimal oversight; indoor plumbing status variable PMCWikipedia
Oklahoma (Stilwell)
Suspected aquifer contamination (mercury); water quality under health investigation
Severe economic distress; indoor plumbing likely but utilities unreliable Wikipedia
Mobile home parks (UT, CO, others)
Most residents rely on private park-run water systems; violation rates ~70%
Indoor plumbing usually present, but water quality poor; toilet/sewer infrastructure sometimes deficient AP NewsAP News
Eastern Coachella Valley, CA
Many rural households rely on well/bottled water; arsenic contamination common
Indoor plumbing present, but water quality distrust high; users avoid tap water AP News
Additional notes from Reddit and anecdotal surveys:
Appalachia (eastern Kentucky, West Virginia, southwest Virginia) has documented households without indoor plumbing well into the 1990s, often relying on springs or gravity-fed systems and outhouses or pit toilets Reddit+13Reddit+13Reddit+13.
Counties with high Native American populations (e.g. Apache & Navajo counties in AZ, Menominee WI) have elevated percentages of households lacking complete plumbing facilities
https://www.azfamily.com+2Reddit+2Reddit+2
Some studies of private wells in southwestern Wisconsin found contamination rates for fecal pathogens in sampled wells as high as 91% (though these were pre-identified high-risk wells) Reddit.
Summary & Recommendations
Rural, low-income regions—especially in Alabama, Mississippi, Kentucky, Oklahoma, and rural California—demonstrate severe deficiencies in both water quality and sanitation infrastructure.
Private well use is widespread, yet often unregulated and insufficiently tested; contamination (bacteria, arsenic, PFAS, mercury) is common.
Many residents do not trust or use tap water, opting instead for bottled or boiled water, sometimes at great expense.
Sanitation failures—including outright absence of indoor plumbing or use of straight-piped systems—remain prevalent in some rural counties and mobile home communities.
Recommendations
Expand state-level well-testing mandates, especially in rural counties with low testing compliance (e.g. Oklahoma, Alabama).
Target infrastructure grants to regions like Lowndes County, Martin County, and rural Mississippi Delta, for both septic systems and lead/arsenic filtration.
Strengthen oversight of mobile home park water systems, following Utah’s and Colorado’s models, mandating testing and remediation for park-level infrastructure.
Implement culturally competent community engagement, particularly in farmworker and Indigenous communities mistrustful of public systems.
Use data-driven targeting using local block data from USGS/EPA tools to identify high-risk counties and prioritize funding.
Address sanitation equity by identifying counties lacking complete plumbing and offering grants or technical support to install indoor toilets and running water.
References
“A public health crisis in the making: Agriculture pollutes underground drinking water in Minnesota.” Reddit, r/minnesota, 13 Jan. 2023. AP NewsarXivPMCThe GuardianAP News+1AP News+1Reddit
“Almost half a million US households lack indoor plumbing: ‘The conditions are inhumane’.” Reddit, r/news, Sept. 2021. Reddit
“Infrastructure neglect and poverty lead to parasites in the Mississippi Delta.” The Guardian, Jan. 2025.
“Many rural towns have neglected drinking water systems for decades.” Reddit, r/Michigan, May 2022. Reddit
“Mobile home parks water safety reports.” Associated Press, July 2025.
“Rural Towns Across Oklahoma Struggle To Keep Water Clean.” Reddit, r/oklahoma, Dec. 2020.
“Stilwell, Oklahoma.” Wikipedia, July 2025.
“Trump rescinds $20 m for clean water in pesticide-contaminated rural California.” The Guardian, July 2025.
Community-driven and water quality indicators of sanitation system failures in a rural U.S. community. Mendoza Grijalva et al., Mar. 2025, arXiv preprint. arXiv
Contamination in U.S. Private Wells. USGS Water Science School, 2015.
Martin County water crisis. Wikipedia, July 2025.
Oklahoma private well protection policies, analysis. PMC/NCBI, policies comparison.
Pollution in Door County, Wisconsin. Wikipedia, recent.