We don't have a macerator but haven't had any issues in the three seasons with our Axis. The rotating sewer outlet does help a lot.
Even in the 10 years we had the 5th wheel with the sewer outlets a good 18-24" off the ground we still found places where the sewer would run uphill and had to deal with it...didn't really matter the height of the camper's outlet, was more the height of the drain in the ground. In fact there are a few campgrounds where the sewer pipe extends a good 6-8" above the ground....
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