"Every single day we use it, every single day, so we're clean all the time -- see, nice and clean," said Chevak resident Earl Atchak, holding up his laundry.
Atchak and his wife, Lisa Unin, grew up without indoor plumbing -- and they're glad their grandchildren have it.
"It was hard hauling water and dumping honey buckets -- it was hard," Unin said.
"When we were young, we used to have a (sewage) lagoon right in front of Chevak, and that lagoon had dead dogs," Atchak said. "That's worse than Third World countries, with a dead dog behind you, a little 2-year-old kid playing."
With the advent of running water, the Atchaks have seen the health of the community improve, both physically and emotionally.
"It changes how you think and feel," Atchak said. "When you have running water, you clean, do dishes all the time, you do laundry all the time. You drink water; you have real, real clean water. It changes you when you step out the door: you have showered already, you're clean, your hands are clean."
The price tag for Chevak's water-sewer system was about $23 million. When water comes out of the ground here, it's visibly impure and full of iron.
"You can smell it too -- ugh," said water plant operator John Atchak as he sniffed a water sample.
Chevak's water needs a lot of treatment to turn it into good drinking water. The farther north you go, the more difficult it is to provide clean water, which makes these systems expensive to maintain. But ANTHC officials say it's worth it.
"The whole reason that we go to rural Alaska to build these water-sewer systems is for health care, is to keep people healthy," said ANTHC's John Nichols. "We figured out that it's cheaper to provide preventative maintenance, water-sewer systems, to keep people healthy, than it is to treat their symptoms and their illnesses in the hospitals."
"There are hard numbers that say, ‘Wow: disease rates skyrocket when you actually don't have water and sewer in your community,'" said ANTHC's Matthew Dixon.
Studies show that death rates for children are cut by 55 percent when water and sewer is introduced in a community. Gastrointestinal problems dropped by 67 percent, and visits to the clinic were down by 58 percent.
Children's rates of hospitalization if they live in homes without running water are equally dramatic. One study found that they had five times more respiratory infections and 11 times more cases of pneumonia, compared with children in homes with running water.
Then there's RSV, the respiratory syncytial virus. The rates of hospitalization for RSV, which causes respiratory infections, are five times higher in communities without running water. Infants from rural Alaska are frequently medevaced to Anchorage's Alaska Native Medical Center -- because RSV can be deadly.
"Things like RSV, kids, their immune systems are compromised for the rest of their lives, so they're going to be hospitalized more and more and more," Dixon said.
Life in rural Alaska is gritty and children suffer the most when there's no clean water, getting more skin infections, colds and flus -- but running water and flush toilets are helping to break the cycle.
In addition to freeing residents from poor health, toilets also mean more free time for economic activities, like making masks that fetch thousands of dollars in Anchorage.
"This will end up in somebody's house," Earl Atchak said, holding up a freshly made seal spirit mask.
Its new home will be far away from Chevak, where people may not realize living out here is an art unto itself.
Having a water-sewer system is a big responsibility for a community, since it means that households receiving those services have to start paying cash. Even though carrying buckets is a lot of work, it doesn't add to your monthly expenses.
It can be a tough transition for some communities. Households don't get water and sewer all at once, so it can be tough to collect enough money to keep the system operating in the beginning.
ANTHC runs a group called the Alaska Rural Utility Collaborative for member communities. ARUC handles bill collecting, charging just enough to cover the costs of maintenance for each town's systems.
Contact Rhonda McBride at email@example.com