Sewer blockages and overflows have significant economic and environmental repercussions on communities. Thus, it is crucial to detect and remove sewer blockages prior to the occurrence of overflows. With the improvement in mobile networks and the development of high-quality and low-power sensors and loggers, wastewater network operators can now adopt monitoring devices enabled by the “Internet of Things” (IoT) technology for real-time monitoring. To this end, this paper studies the current state-of-the-art in sewer blockage management and introduces a novel methodology to monitor sanitary sewer blockages to prevent sanitary sewer overflows (SSO) with the least human interaction. The proposed system incorporates low-power level sensors and 4G telemetry for real-time monitoring of the manhole's sewage level to detect sewer blockages. The blockage detection methodology encompasses a set of decision rules and time series analysis to identify blockage events. The final blockage detection model offers a versatile capability to be implemented on sanitary sewer networks of different types with minimum computational costs.