The goal of this study was to gain a better understanding of the PO4-P treatment efficiency of onsite wastewater systems (OWS) installed in nutrient-sensitive watersheds of the North Carolina Piedmont. Four OWS including two conventional and two single-pass sand filter (SF) systems were evaluated at sites with clay-rich soils. Piezometers were installed near all of the OWS, and down-gradient from the conventional OWS for groundwater collection and characterization. Septic tanks, groundwater, SF effluent, and surface waters were sampled each season during 2015 (five times) and analyzed for PO4-P and Cl concentrations and for various environmental parameters. The conventional and SF OWS reduced PO4-P concentrations by an average of 99% and 90%, respectively, before discharge to surface waters. Mass-load reductions of PO4-P were also greater for the conventional OWS (mean 95%), relative to SF (83%) systems. The effluents discharged by SF OWS were influencing surface water quality. Additional treatment of the effluent from single-pass SF with reactive media is suggested, along with monitoring of the final effluent for PO4-P concentrations. This research provides important information that is absent from the published literature concerning PO4-P contributions to water resources from OWS in clay soils.