A pilot-scale upflow anaerobic sludge blanket-moving bed biofilm (UASB-MBB) reactor followed by a high-rate algal pond (HRAP) was designed and operated to remove organic matter, nutrients and pathogens from sewage and to facilitate reuse. For an influent chemical oxygen demand (COD) concentration of 233 ± 20 mg/L, final effluent COD was 50 ± 6 mg/L. Successful biomass granulation was observed in the sludge bed of the upflow anaerobic sludge blanket (UASB) reactor after 5 months of operation. Ammonia removal in HRAP was 85.1 ± 2.4% with average influent and effluent ammonia nitrogen concentrations of 20 ± 3 mg/L and 3 ± 1 mg/L, respectively. Phosphate removal after treatment in the HRAP was 91 ± 1%. There was a 2–3 log scale pathogen removal after treatment in HRAP with most probable number (MPN) of the final effluent being 600–800 per 100 mL, which is within acceptable standards for surface irrigation. The blackwater after treatment in UASB-MBBR-HRAP is being reused for gardening and landscaping. This proper hydro-dynamically designed UASB reactor demonstrated successful granulation and moving bed media improved sludge retention in UASB reactor. This combination of UASB-MBB reactor followed by HRAP demonstrated successful sewage treatment for a year covering all seasons.