Sewage may contain high levels of the nutrients nitrogen and phosphorus. Typical values for nutrient loads per person and nutrient concentrations in raw sewage in developing countries have been published as follows: 8 g/person/d for total nitrogen (45 mg/L), 4.5 g/person/d for ammonia-N (25 mg/L) and 1.0 g/person/d for total phosphorus (7 mg/L). The typical ranges for these values are: 6-10 g/person/d for total nitrogen (35–60 mg/L), 3.5-6 g/person/d for ammonia-N (20–35 mg/L) and 0.7-2.5 g/person/d for total phosphorus (4–15 mg/L).
Excessive release to the environment can lead to nutrient pollution, which can manifest itself in eutrophication. This process can lead to algal blooms, a rapid growth, and later decay, in the population of algae. In addition to causing deoxygenation, some algal species produce toxins that contaminate drinking water supplies.
Ammonia nitrogen, in the form of free ammonia (NH) is toxic to fish. Ammonia nitrogen, when converted to nitrite and further to nitrate in a water body, in the process of nitrification, is associated with the consumption of dissolved oxygen. Nitrite and nitrate may also have public health significance if concentrations are high in drinking water, because of a disease called metahemoglobinemia. 
Phosphorus removal is important as phosphorus is a limiting nutrient for algae growth in many fresh water systems. Therefore, an excess of phosphorus can lead to eutrophication. It is also particularly important for water reuse systems where high phosphorus concentrations may lead to fouling of downstream equipment such as reverse osmosis.
A range of treatment processes are available to remove nitrogen and phosphorus. Biological nutrient removal (BNR) is regarded by some as a type of secondary treatment process, and by others as a tertiary (or advanced) treatment process.