If they *can* be built lower I imagine that designers would try to do so, but more often than not sewer lines have pumping stations periodically along their length.
E.g. an underground sewer pipe is positioned to flow downhill for some number of miles, and when it gets too deep to be convenient a pumping station brings it back up, and it flows downhill some more. If you imagine a cross section view along the whole length, it would look like a sawtooth.
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