A wastewater treatment system has to remove suspended material, dissolved OM, pathogens and dissolved inorganic material. Such treatment systems must fulfill many requirements to be feasibly implemented, such as simple design, use of non-sophisticated equipment, high treatment efficiency, and low operating and capital costs. Conventional nitrification/denitrification and other alternatives are proposed to remove N. Anaerobic processes achieve high OM removal efficiencies without oxygen requirement. Anaerobic membrane technology can produce a solid free effluent, and enables short HRT and high SRT. To obtain an effluent that meets requirements of the environmental legislation regarding N and protects the receiving water bodies, anaerobic membrane bioreactors can play an important role with post-treatment systems based on biofilters and sequencing batch reactors among others. Much progress has been achieved in the last years in terms of understanding the pollutants elimination from wastewater. However, some challenges must still be overcome before a sustainable and efficient domestic wastewater treatment technology is achieved.