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No, you do not need a garbage disposal to have a dishwasher. A dishwasher will work without one, and while it's rare to see a home with a dishwasher that doesn't have a disposal, it is possible. The two appliances pair well and are often installed together because a disposal simplifies meal cleanup.

However, your dishwasher should not be used as a replacement for a garbage disposal. Subjecting it to continuous food leftovers can lead to major clogs. If you choose not to install a garbage disposal, you should thoroughly rinse your plates or scrape excess food into the trash or a compost pile before loading them into the dishwasher to prevent plumbing issues.

Your garbage disposal will only affect the health of your septic tank if you’re using it too frequently, or filling it with organic waste that doesn’t fully break down. If the tank fills up with too many solids, the bacteria won’t have enough time to consume it before more is added, which can lead to an overflow in the drain field. Your tank will need to be pumped more frequently with excessive or improper garbage disposal use.

The main issue with garbage disposals is clogging. This can mean a clogging of the pipes that expel the food along with water, or a clogging of the mechanical parts themselves. The problem lies in the solution because you can’t easily see clogs if they’re inside the system, and reaching in to dislodge stuck items is a risky proposal. Call a pro and ask what they would do, but if you can’t see the clog easily, and running the unit won’t free it, you need to let a professional handle the fix. 

While the drain connection for a garbage disposal is nearly universal and fits standard sink drain holes of 3 1/2 to 4 inches, the size of the disposal unit itself is not. You must have enough space in the cabinet underneath your sink to accommodate the disposal's housing. A larger model may not fit in a compact cabinet or if the existing plumbing is arranged in an unusual way. Before buying a new garbage disposal, measure the available space under your sink. If you are replacing an old unit, it's often easiest to choose a new model of a similar size.