The TOTO Aquia IV elongated skirted toilet Bowl with CEFIONTECT is designed for use with the Aquia IV tank. When paired with its tank, the Aquia IV features TOTO's DYNAMAX TORNADO FLUSH, utilizing a 360 degree cleaning power to reach every part of the bowl. The enhanced design of the Aquia IV inner bowl reduces water flow resistance and turbulence, resulting in a quieter flush. When paired with its tank, the Aquia IV meets the standards for EPA WaterSense, and California's CEC and CALGreen requirements. The Aquia IV comes ready for install into a 12" rough-in, but may be adapted for a 10" or 14" rough-in with the purchase of a separately sold adapter. Additional items needed for installation and use must be purchased separately: tank, wax ring, toilet mounting bolts, water supply lines, and toilet seat.