This article examines the theory and practice of biological treatment of drinking water. The removal of ammonia and the basics of nitrification are discussed. The European practice of nitrification and treatment processes to enhance nitrification that use attached or biofilm bacteria that accumulate to give a large solids retention time such as biological filtration, fluidized bed filtration (also called biological sedimentation filtration), rapid sand filtration, and nitrification within granular activated carbon beds are described. Good removal is possible with these processes, even at low temperatures. A quantitative kinetic model that provides a basis for the design and operation of biological water treatment processes is presented. The biological removal of biodegradable organic matter and biological manganese oxidation are addressed. The authors recommend following the biological process with conventional processes to provide multiple barriers against the escape of microorganisms into the finished water. Includes 67 references, tables, figures.