In this study, the single-stage partial denitrification-anammox (PD-A) process was started-up in 22 days in a lab-scale up-flow sludge blanket (UASB) reactor to treat wastewater containing NH4+-N and NO3−-N simultaneously. The TN removal rate reached 97.08% with a low effluent TN of 10 mg/L. High-throughput sequencing results revealed the dominant bacterial strains were related to the genus of Thauera and Candidatus Kuenenia. The PD-A system was started-up based on the optimized PD process via inoculated exogenous anammox sludge attributing to the improvement of bacterial adaptation and co-existence by EPS. The PD process was realized in 18 days with the abundance of PD functional bacterium Thauera through fluctuated C/NO-3-N conditions. Moreover, the detrimental effects of starvation on anammox was weaker than that on PD bacteria. The PD-A process was expected to open a new possible perspective in designing NO3−-N and NH4+-N wastewater treatment plants.