A device generating low-frequency and low-intensity ultrasound waves was used for mitigating biofilm accumulation and scaling. Two systems were tested: a lab-scale plate heat exchanger operated with continuously recycled water and a continually fed flow-through drinking water pilot used for mimicking water circulation in pipes. Initial deposition of bacterial cells was not prevented by ultrasound wave treatment. However, whatever the tested system, both further calcium carbonate deposition and biofilm growth were markedly inhibited. Biofilms formed in reactors subjected to low-frequency and low-intensity ultrasound waves were weakly attached to the material. Even though the activity of bacteria was affected as shown by their lower cultivability, membrane permeability did not appear compromised. Ultrasound technology sounds very promising in both the mitigation of drinking water biofilm and carbonate accumulations.