Untreated and minimally treated wastewater discharged into the environment have the potential to adversely affect groundwater dependent ecosystems and nearshore marine health. Addressing this issue requires a systems approach that links land use and wastewater management decisions to potential impacts on the nearshore marine environment via changes in water quality and quantity. To that end, a framework was developed to assess decisions that have cascading effects across multiple elements of the ridge-to-reef system. In an application to Kona (Hawai‘i, USA), eight land use and wastewater management scenarios were evaluated in terms of wastewater system upgrade costs and wastewater related nutrient loads in groundwater, which eventually discharge to nearshore waters, resulting in potential impacts to marine habitat quality.