SSO is distinct from a combined sewer overflow (CSO), a similar problem of untreated sewage discharges, but which occurs only in a municipal system specifically designed with a combined sewer.
Since medieval times rulers have been aware of the impact of raw sewage improperly discharged to the environment. Before treatment systems existed in 16th century England, King Henry VIII decreed that sewage troughs should be kept flowing so that they would not stagnate in London prior to reaching the River Thames. (London sewer system) It was not until the 19th century when America and parts of Europe developed wastewater treatment, that the concept of SSO materialized; however, communities were merely happy to have wastewater treatment systems, and did not complain greatly about overflows until the dawning of 20th century environmental awareness in the 1960s. At that time the USA began recognizing locations and frequencies of SSOs in a systematic way. Local governments heard complaints of citizens, beach closure protocols were systematised and the U.S. Environmental Protection Agency (EPA) began detailed engineering analyses for major cities across the country. After passage of the U.S. Clean Water Act in 1972, the 1980s saw spending of billions of dollars on system upgrading (although most funds during this period were spent on upgrades to secondary treatment rather than addressing SSO problems). In the 1990s Japan, the UK and a number of other European countries began earnest investigation of some of their countries’ overflow issues.
By far the most prevalent cause of Sanitary Sewer Overflow stems from heavy rainfall events which can cause massive infiltration of stormwater into sewerage lines. The combined flow of wastewater and stormwater exceeds the capacity of the sewer system and is released into local waterways to prevent flooding in homes, businesses and streets. This circumstance is most prevalent in older cities whose subsurface infrastructure is quite old; Paris, London, Stockholm, New York, Washington, DC, and Oakland, California are typical examples of such locations. Inflow into the sanitary lines can be caused by tree root rupture of subsurface lines or by mechanical fracture due to age and overpressure from trucks and buildings above.
Other modes of system failure can include power outage which may disable lift station pumps or parts of the treatment plant operations themselves; in fact, any mechanical system failure within a treatment plant can create a circumstance leading to overflow: breakdown of rotating arms of trickling filters, jamming of line gates, clogging of filters or grates etc. Furthermore, some forms of human error can infrequently lead to diversion of sewage and result in an overflow event.
Decentralized failures in dry weather mainly occur from collection sewer line blockages, which can arise from a debris clog, line rupture or tree root intrusion into the line itself. One of the main problems of a decentralized line failure is the difficulty of defining the location of overflow, since a typical urban system contains thousands of miles of collection pipage, and the central treatment plant has no way of communicating with all the lines, unless expensive monitoring equipment has been installed.
Human health impacts include significant numbers of gastrointestinal illness each year, although death from one overflow event is uncommon. Additional human impacts include beach closures, swimming restrictions and prohibition against consumption of certain aquatic animals (particularly certain molluscs) after overflow events. Ecological consequences include fish kills, harm to plankton and other aquatic microflora and microfauna. Turbidity increase and dissolved oxygen decrease in receiving waters can lead to accentuated effects beyond the obvious pathogenic induced damage to aquatic ecosystems. It is possible that higher life forms such as marine mammals can be affected since certain seals and sea lions are known to experience peaks in pathogenic harm.
Thus the US, Canada, Western Europe, Australia and Japan are considered struggling with a public health problem of SSO prevention, while the underdeveloped countries of the world discharge approximately 20,000 times the amount of raw sewage into the environment as those advanced countries collectively; thus, lesser developed countries discharge approximately (the equivalent of) 100 trillion US gallons (380 km³) of untreated sewage per annum. This dichotomy of expenditure and public health benefit is arguably the greatest disparity between developed and underdeveloped nations as of the year 2006.