This study assessed and compared septage management systems in Baliwag, Calamba, Muntinlupa, Pasig, and San Fernando, the Philippines, using fecal waste flow diagrams and service delivery scorecards. According to the fecal waste flow diagrams, San Fernando is the most successful in preventing its environment’s pollution. It is followed by Baliwag, Muntinlupa, and Pasig. In Calamba, all of the fecal waste is disposed of to the environment. According to the scorecards, Pasig has the most efficient septage management service, followed by San Fernando, Baliwag, Muntinlupa, and Calamba. Among the five areas, San Fernando can be considered to have the most efficient septage management system as it had the best fecal waste flow diagram and second highest ratings in the service delivery scorecard. It might have been an advantage that the city itself is managing the whole system—from implementing rules for septic tank plans, to the collection, treatment, and disposal of septage.