Its macerating pump processes the waste and pumps it up to 26 ft. up or 197 ft. across to the sewer line, so you can add a toilet where standard plumbing isn't available, and Anzzi says it can also take a sink, shower or bathtub. The Nesso toilet has a rear outlet and a 7 in. rough-in. The pump plugs into a dedicated outlet, so have a licensed electrician size the circuit, and Anzzi recommends professional installation.