There is little knowledge regarding the environmental sustainability of domestic on-site or decentralised wastewater treatment systems (DWWTS). This study evaluated six unique life cycle environmental impacts for different DWTTS configurations of five conventional septic tank systems, four packaged treatment units, and a willow evapotranspiration system. Similar freshwater eutrophication (FE), dissipated water (DW), and mineral and metal (MM), burdens were noted between the packaged and conventional system configurations, with the packaged systems demonstrating significantly higher impacts of between 18% and 56% for climate change (CC), marine eutrophication (ME), and fossils (F). At a system level, higher impacts were observed in systems requiring (i) three vs. two engineered treatment stages, (ii) a larger soil percolation trench area, and (iii) pumping of effluent. The evapotranspiration system presented the smallest total environmental impacts (3.0–10.8 lower), with net benefits for FE, ME, and MM identified due to the biomass (wood) production offsetting these burdens. Further analysis highlighted the sensitivity of results to biomass yield, operational demands (desludging or pumping energy demands), and embodied materials, with less significant impacts for replacing mechanical components, i.e., pumps. The findings highlighted the variation in environmental performance of different DWTTS configurations and indicated opportunities for design improvements to reduce their life cycle impacts.