Combined with the specific engineering examples, this paper focus on analyzing the present situation, characteristics and problems of sewage collection and transportation systems of villages and towns in low mountain and hilly areas. The technical route and selection principle of sewage pipeline design were proposed pertinently. The difficulties of sewage pipelines crossing rivers, steep slopes and other obstacles were analyzed and the solutions were proposed. By solving the problems of sewage pipeline planning and construction, the reasonable operation of the whole sewage collection and treatment system was finally realized, which had a wide range of economic and social benefits.