The Great Bay Estuary, known as the “jewel of the New Hampshire seacoast,” is located in one of the fastest-growing regions in New England. Increasing population growth resulting in substantial land development is contributing to increased wastewater generation and some increased nutrient loadings to the Great Bay Estuary. Seventeen wastewater treatment facilities (WWTF) discharge to the Great Bay watershed. Some of the WWTF discharges do not meet current limits and others are not able to meet future limits, which are expected to include nitrogen and phosphorus. Important concerns that guided development of the wastewater management alternatives for this study included water quality protection, habitat protection, and sustainable growth management within the 44-community study area. The study resulted in the selection of four alternatives for the New Hampshire Seacoast Region: a regional centralized collection system with local treatment and subsequent offshore discharge to the Gulf of Maine; upgrading existing WWTFs and discharging treated effluent to existing surface water discharge locations; requiring decentralized wastewater treatment and local discharge for a significant portion of all new growth; and treating wastewater locally and discharging to local land application sites. The study does not recommend a particular alternative to implement. Rather, the intent of the study is to present a number of issues and impacts associated with the implementation of the four alternatives and allow stakeholders to subsequently decide on the next steps for wastewater management for this region.