The effects of C/N ratio and total organic carbon (TOC) loading on nitrogen removal through simultaneous nitrate reduction and anaerobic ammonium oxidation in a single reactor were examined. Granular sludge taken from a methane fermentation reactor was placed in an upflow reactor and supplied with synthetic wastewater containing nitrate at a C/N ratio of 1 to grow heterotrophic denitrifying bacteria. When nitrogen removal ratio reached 30%, anammox sludge attached to nonwoven-carrier was added into the same reactor and then ammonia was added to the synthetic wastewater. Nitrogen removal ratio was markedly increased to 80-94%. In this system, nitrogen removal ratio was affected by C/N ratio and TOC loading, not by the amount of granular sludge. A stable isotopic analysis using N-15-labeled nitrate showed that N-2 gas was formed by anammox reaction.