This paper deals with an almost 1-year long pilot study of a nitritation-denitritation process that was followed by anammox polishing. The pilot plant treated real municipal wastewater at ambient temperatures. The effluent of high-rate activated sludge process (hydraulic retention time, HRT = 30 min, solids retention time = 0.25 d) was fed to the pilot plant described in this paper, where a constant temperature of 23 °C was maintained. The nitritation-denitritation process was operated to promote nitrite oxidizing bacteria out-selection in an intermittently aerated reactor. The intermittent aeration pattern was controlled using a strategy based on effluent ammonia and nitrate + nitrite concentrations. The unique feature of this aeration control was that fixed dissolved oxygen set-point was used and the length of aerobic and anoxic durations were changed based on the effluent ammonia and nitrate + nitrite concentrations. The anaerobic ammonia oxidation (anammox) bacteria were adapted in mainstream conditions by allowing the growth on the moving bed bioreactor plastic media in a fully anoxic reactor. The total inorganic nitrogen (TIN) removal performance of the entire system was 75 ± 15% during the study at a modest influent chemical oxygen demand (COD)/NH4+-N ratio of 8.9 ± 1.8 within the HRT range of 3.1–9.4 h. Anammox polishing contributed 11% of overall TIN removal. Therefore, this pilot-scale study demonstrates that application of the proposed nitritation-denitritation system followed by anammox polishing is capable of relatively high nitrogen removal without supplemental carbon and alkalinity at a low HRT.