A recurring challenge for human societies has been the provision of freshwater and the disposal of wastewater. Initial systems were very rudimentary but became more and more complex as cities and towns emerged around the world over time. With the Industrial Revolution and rapidly burgeoning urbanisation in western Europe and the United States in the 19th century, water supply and sewerage eventually were designed and constructed as citywide technological systems. The aim of this chapter is to describe and analyse the most important stages of technological change in urban wastewater management during the period 1830 to 2010, with examples taken primarily from Sweden, northern Europe, and the United States. The chapter begins with a brief discussion of wastewater management before the modern era, then turns to technological change in modern wastewater management and practices over three periods: 1830–1900, from drainage to sewerage – the British public health movement and the evolution of sewerage systems; 1900–1950, the bacteriological health paradigm and the dawn of wastewater treatment; and 1950–2010, wastewater innovation and renovation, suburban sprawl, and the age of environmental awakening.