Wastewater management has been practised for several millennia, evolving and improving throughout human history. The Etruscans developed channel systems to collect different water flows, and the Romans assimilated these techniques, improving and adapting them to their needs. The most advanced segment of the Roman sewage system was the covered Cloaca Maxima, the largest among the various wastewater collectors. First built as an open freshwater canal, it was transformed around the second and first centuries BC into a monumental underground tunnel with tuff walls and vaults. It is a masterpiece of hydraulic engineering and architecture and it became the central piece of a sanitation network that delivered hygiene services to the hills around Rome. To drain the rainwater from the streets into the Cloaca, the Romans built special circular drains shaped as large masks, representing river gods swallowing water. Another distinctive feature of the Roman sewage system was the required fee for using the public latrines or renting chamberpots, making it one of the first historical examples of a user-pays approach to sanitation services. An 1889 study of the Cloaca Maxima and some other sewers led to the restoration of parts that could be connected to the “modern” sewer system and used in a project that continues to benefit Rome to this day.