One of the real illusion breakers we will have to try and counteract is the need for water.
Lots could possibly be modded to not require water. Perhaps a spring can be modded to provide water to a whole large region, negating the need to lay pipes...
However this model I came across reminded me that there was at least one kind of mostly underground piped water system at the time - the aquaducts. Now I'm certainly NOT suggesting that aquaducts replace the in game water system, nothing could be less realistic. But I can't yet rule out their inclusion in some way.
Then I remembered this snippet from Sim:
As for the utilities, water was definitely a needed resource in any type of human existence and using wells (in all shapes and sizes) should be kept as it is (plus local quirks, as in leftover roman acqueducts or underground reservoirs).
Ah yes, wells. Certainly they can be the source, I just want to avoid having to lay pipe if at all possible. So I assume then, that a well can be made at least big enough to provide for a small community - so that a large city might require several.
Speaking of which, how did people in cities get their water?
Cities were built near rivers or lakes. That's why all the medieval european cities are next to rivers... In larger cities, wells were added for extra water. So I agree with the post above.
Aquaducts were roman buildings, sometimes still used in medieval times but they had no idea on how to fix them if they broke down. So I wouldn't add aquaducts to the game.
Ther definetely shouldn't be any need for pipes, even though very few did exist.
Usually the people had to go to the nearest well / fountain / river to get their water.
I would leave the acqueducts in-game as an option, especially to transport water from further away to the cities. That means that maybe they shouldn't actually have a pipe effect, but rather kind of function like power lines, that is for transport purposes only. Maybe they could be made to end in reservoirs from which some other system might be used for distribution.