Odor emissions from sewer systems are a persistent environmental concern in urban areas, particularly in combined sewer systems where septic tanks are widely used. However, the contribution of septic tanks as sources of sewer odor has not been sufficiently quantified. This study investigated the characteristics of hydrogen sulfide (H2S) generation in septic tanks and evaluated its potential influence on sewer odor, as well as the effectiveness of odor mitigation technologies. Field investigations were conducted in combined sewer areas to measure aqueous H2S concentrations in septic tanks. The results showed that H2S concentrations in septic tanks were not significantly affected by septic tank capacity (ANOVA, p > 0.05), suggesting that tank size or user population is not a primary determinant of sulfide generation. In contrast, aqueous H2S exhibited a positive correlation with chemical oxygen demand (COD), indicating that organic matter availability plays an important role in sulfide production through microbial sulfate reduction processes. A significant relationship was observed between aqueous H2S in septic tanks and gaseous H2S measured at catch basins, demonstrating that sulfide derived from septic tanks can transfer to the sewer atmosphere and potentially impact human odor exposure in urban environments. In addition, the performance of odor control technologies applied to septic tanks was evaluated with aeration-based technologies found to significantly reduce H2S concentrations. These findings suggest that septic tanks can serve as important sources of sewer odor highlighting the need for effective management and proper operation of septic tank odor control systems in combined sewer areas.