Short answers, pulled from the story.
The year 500 BC marked the beginning of Rome's first sewers. Roman engineers copied drainage technology from their neighbors, the Etruscans to create underground ditches designed to move rainwater away from the city.
Scholars believe this great sewer was built during the reign of three Etruscan kings in the sixth century BC. Agrippa reconstructed and renovated the main channel around 33 BC when he served as Aedile.
The Aqua Appia entered the city in 312 BC under the supervision of censor Appius. Frontinus mapped the entire distribution network toward the end of the first century AD while serving as water commissioner appointed by Emperor Nerva.
Waste flowed through a sewer system resembling a stream into the Cloaca Maxima below. Terra cotta pipes carried waste water from homes using concrete seals to resist high pressure.
Disease remained rampant throughout ancient Rome despite advanced sanitation infrastructure. Widespread intestinal worms caused dysentery across the population regardless of engineering achievements.