The performance of a laboratory-scale sewage treatment system composed of an up-flow anaerobic sludge blanket (UASB) reactor and a moving bed biofilm reactor (MBBR) at a temperature of (22–35 °C) was evaluated. The entire treatment system was operated at different hydraulic retention times (HRT’s) of 13.3, 10 and 5.0 h. An overall reduction of 80–86% for CODtotal; 51–73% for CODcolloidal and 20–55% for CODsoluble was found at a total HRT of 5–10 h, respectively. By prolonging the HRT to 13.3 h, the removal efficiencies of CODtotal, CODcolloidal and CODsoluble increased up to 92, 89 and 80%, respectively. However, the removal efficiency of CODsuspended in the combined system remained unaffected when increasing the total HRT from 5 to 10 h and from 10 to 13.3 h. This indicates that, the removal of CODsuspended was independent on the imposed HRT. Ammonia-nitrogen removal in MBBR treating UASB reactor effluent was significantly influenced by organic loading rate (OLR). 62% of ammonia was eliminated at OLR of 4.6 g COD m−2 day−1. The removal efficiency was decreased by a value of 34 and 43% at a higher OLR’s of 7.4 and 17.8 g COD m−2 day−1, respectively. The mean overall residual counts of faecal coliform in the final effluent were 8.9 × 104 MPN per 100 ml at a HRT of 13.3 h, 4.9 × 105 MPN per 100 ml at a HRT of 10 h and 9.4 × 105 MPN per 100 ml at a HRT of 5.0 h, corresponding to overall log10 reduction of 2.3, 1.4 and 0.7, respectively. The discharged sludge from UASB–MBBR exerts an excellent settling property. Moreover, the mean value of the net sludge yield was only 6% in UASB reactor and 7% in the MBBR of the total influent COD at a total HRT of 13.3 h. Accordingly, the use of the combined UASB–MBBR system for sewage treatment is recommended at a total HRT of 13.3 h.