Combined sewer overflows (CSOs) pollute receiving waters and have a negative impact on ecosystem services. In urban areas rehabilitation of the sewer system to avoid CSOs is associated with high investment costs. Furthermore, not all CSOs can be closed due to the need for hydraulic reliability of the system. Local treatment of CSO with high rate filtration offers an alternative to rehabilitation of the sewer system that is flexible with respect to design and has lower investment cost than separating sewage and storm water runoff. Results from DESSIN, a 4-year EU demonstration project, are presented. The results showed on average 50% removal of particulate matter during CSO events, with higher removal (80%) in the initial first flush period. Other constituents, for example heavy metals, were removed through their association with particles. Potential impacts on ecosystem services in the catchment and the sustainability of the solution were assessed.