Attachment C - Phase II Site Selection and Evaluation Report (Whiteriver Template).pdf

Tab E – Phase II SSER

03/26/22

WHITERIVER INDIAN HOSPITAL

AND QUARTERS

PHASE II

SITE SELECTION AND EVALUATION REPORT

FORT APACHE INDIAN RESERVATION

NAVAJO COUNTY, ARIZONA

PHOENIX AREA INDIAN HEALTH SERVICE

MICHAEL WELCH, ASSOCIATE DIRECTOR

OFFICE of ENVIRONMENTAL HEALTH & ENGINEERING

PHOENIX AREA INDIAN HEALTH SERVICE

40 NORTH CENTRAL AVENUE, SUITE 720

PHOENIX, ARIZONA 85004

OFFICE OF ENVIRONMENTAL HEALTH & ENGINEERING

DIVISION OF FACILITIES ENGINEERING

July 2019

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Table of Contents Page i

TABLE OF CONTENTS

I. EXECUTIVE SUMMARY

A. Project Summary 1 B. Review Team 2 C. Conclusions and Recommendations 2

II. BASIC PROJECT DATA

A. IHS Area 6 B. Facility Name and Location 6 C. Type of Health Care Facility 6 D. Project Type 6 E. Proposed Health Care Services 6 F. Health Care Facility Size 8 G. Inpatient Beds (Residential Treatment) 8 H. Projected Annual OPV 8 I. Projected Annual Dental Service Minutes 8 J. Staff 9 K. Staff Having Government/Tribal Vehicles 9 L. General Use Government/Tribal Vehicles 9 M. Buses / Vans 9 N. Staff Quarters 9 O. Special Components 9

III. LAND AREA REQUIREMENTS

A. Land Area Required for Proposed Health Care Facility 10 B. Special Site Requirements 10 C. Land Area Required for Proposed Staff Quarters 10 D. Land Area Required for Proposed Parking 10 E. Total Land Area Required 11

IV. UTILITIES REQUIREMENTS

A. Water Supply 13 B. Sewage Disposal 13 C. Electric 13 D. Fuel 14 E. Solid Waste 14 F. Hazardous Waste Disposal 14 G. Telephone 14 H. Telecommunications (Television) 15

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Table of Contents Page ii

V. TECHNICAL EVALUATION

A. Review of Basic Site Data and Service Requirements 16

1. Land Area Size 16

2. Location 17

3. Current Population 18

4. Economy 18

5. Housing 18

6. Community Services 19

7. Fire Protection 20

8. Access 20

9. Transportation 21

10. Unique Considerations 21

11. Climate 21

12. Topography 21

13. Visual 22

14. Air Quality 22

15. Surface Water 22

16. Flood Clearance 23

17. Types of Soil 23

18. Archaeological and Cultural Resources Clearance 24

19. Existing Water Supply System 24

20. Existing Sewage Disposal System 26

21. Existing Electrical Power System 27

22. Existing Fuel Supply System 28

23. Existing Solid Waste Disposal System 28

24. Existing Hazardous Waste Disposal System 28

25. Existing Telephone System 28

26. Existing Telecommunications (Television) System 29

B. Evaluation and Anticipated Site Costs 29

1. Site Features 29

i. Topography & Natural Features 29

ii. Size & Configuration 29

iii. Adjacent Land 30

iv. Existing Improvements on the Proposed Site 30

v. Soil Conditions & Foundation Considerations 31

2. Site Access 32

i. Location 32

ii. Roads/Access to Proposed Site 32

iii. Fire Fighting Capability 33

3. Site Orientation 34

4. Transportation 35

5. Utility Systems 35

i. Water Supply 35

ii. Sewage Disposal 36

iii. Electrical Service 37

iv. Fuel Sources 38

v. Solid Waste Disposal 38

vi. Hazardous Waste Disposal 38

vii. Telephone, Data & Television 39

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Table of Contents Page iii

6. External Influences 39

7. Environmental Assessment 40

8. Other Requirements 40

9. Additional Data 41

VI. CONCLUSIONS AND RECOMMENDATIONS

A. Conclusions 42 B. Recommendations 43

TABS

Phoenix Area Maps .......................................................................................... Tab 1 Project Vicinity Maps ...................................................................................... Tab 2 Project Site Maps ............................................................................................. Tab 3 Phase I Site Selection and Evaluation Report .................................................. Tab 4 Tribal Resolutions Relating to Proposed Site .................................................. Tab 5 Site Survey Plan ............................................................................................... Tab 6 Floodplain Assessment .................................................................................... Tab 7 Preliminary Geotechnical Evaluation Report .................................................. Tab 8 Cultural Resources Survey ............................................................................... Tab 9 Will Serve Letters & Correspondence .......................................................... Tab 10 Environmental & Biological Assessments..................................................... Tab 11 Traffic Impact Study ...................................................................................... Tab 12 White River Indian Hospital Fire Hydrant Flow Tests .................................. Tab 13

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Executive Summary Page 1

I. EXECUTIVE SUMMARY

A. Project Summary

During the development of this Phase II Site Selection Evaluation Report (SSER) the 2000 Program Justification Document (PJD) and the 2000 Program of Requirements (POR) for the Whiteriver Indian Hospital (WIH) and staff quarters were undergoing major updates. Although neither have been completed, the author of this report worked closely with the Phoenix Area Office Indian Health Service (IHS) Planner to incorporate the most up-to-date design information into this report.

The Whiteriver Indian Hospital and staff quarters are IHS funded and will be located on the White Mountain Apache Tribe (WMAT) Indian Reservation. The new hospital will continue to serve the WMAT and surrounding region.

The site of the new hospital is adjacent to the existing WIH on Arizona State Route 73, in the northern section of the community of Whiteriver. The new quarters site is located southeast of the Hon-Dah Resort and Casino, adjacent to the intersection of AZ SR 73 and 260.

The new Whiteriver Indian Hospital is planned to be 400,000 ft2 with a total estimated capital cost of more than $390 million. This proposed facility will provide much needed inpatient services and a full range of ambulatory care services to the Native American populations served by the Whiteriver Service Unit. In particular, this facility will have the greatest impact on the health and wellbeing of the more than 19,270 (Projected 2025 extended service area) members of the WMAT. The WIH will expand the existing disciplines: ambulatory care, emergency department/EMS, surgical specialty services, medical specialty services, behavioral health, acute care inpatient, surgery, ancillary services, preventive care, administrative support, facility support, and additional services (Tribal and other).

In addition, new services added will consist of intensive care, inpatient surgery C-section, mammography, speech therapy, sleep study, and hospice.

The facility will have a workforce of 981 IHS staff and 47 tribal staff, totaling 1,028 employees. The construction of staff quarters is required due to the shortage of private housing available in the nearby communities.

A Phase I SSER was completed in March 2017 and approved by the Phoenix Area Indian Health Service (PAIHS) that same month. The report evaluated and ranked 4 sites proposed by the WMAT through a tribal resolution. All 4 of these sites were later re-evaluated by the tribe and deemed unsuitable. A new tribal resolution was

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Executive Summary Page 2 passed on October 2017 (10-2017-232) which rescinded the 4 original sites and proposed 3 new sites for consideration.

On November 8, 2017, representatives from the IHS were invited by WMAT officials to meet on-site and review the 3 new locations. A 6 member team, comprised of an appointed representative from the PAIHS Office, 2 representatives from the Whiteriver IHS Service Unit and 3 representatives from the WMAT, conducted a second Phase I Site Selection field visit for the new WIH Replacement Facility.

The second Phase I SSER was completed in November 2017 and approved by the Phoenix Area IHS that same month. The report evaluated and ranked 3 sites offered by the WMAT through a tribal resolution. One of the sites is the existing WIH site and the other 2 are Canyon Day sites located south of the existing WIH located in Whiteriver, AZ. After field inspections of the 3 sites, the team arrived at a consensus that the site at the existing WIH was the most feasible for construction for reasons outlined in the technical evaluation section.

B. Review Team

This report was prepared by the Phoenix Area Indian Health Service, under the direction of Bryan Fischer, Area Project Manager, Division of Facilities Engineering, PAIHS. Assistance was provided by CAPT Steve McGovern, Acting Director, Division of Facilities Engineering, PAIHS. Final approval was issued by CAPT Mike Welch, Associate Director, OEH&E, PAIHS.

C. Conclusions and Recommendations

The site of the proposed hospital is adjacent to the existing WIH on AZ State Route (SR) 73, in the northern section of the community of Whiteriver. The new hospital site lies at 33°52’31.67” North Latitude and 109°57’34.29” West Longitude; (Sec.

31, T6N, R23E, Gila-Salt River Baseline Meridian), and is shown on USGS Quadrangle Map Alchesay Flat. Elevation near the hospital site is around 5,500 feet above mean sea level, sloping generally to the south. The existing WIH site consists of approximately 64.623 acres. Construction of the new WIH on the existing hospital site will work with the following assumptions (1) location of the 144 quarters will be on a parcel of land referred to as Hon Dah, (2) at the existing hospital site, the new WIH will be constructed on the southernmost 14 acres of the existing hospital campus which is currently undeveloped, and (3) after construction of the new WIH and some of the parking spaces, the existing hospital would be demolished along with other obsolete buildings to make room for additional parking spaces and an access road to the existing quarters north of the hospital.

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Executive Summary Page 3

The surface soils within the hospital site consist primarily of low to medium plasticity clay. Layers of clayey gravel with and without sand and cobbles (GC), sandy clay and clay with gravel (CL), gravel (GP) were also encountered during the field exploration. The underlying subsurface material consisted of well weathered very hard gray igneous bedrock (basalt) which caused auger refusal in 18 of the boring locations ranging in depth from 2 and 24 feet below the existing surface elevation. No groundwater was encountered within the soil test borings at the hospital site. It is anticipated that groundwater will not be a factor in design or construction of the planned improvements, within the depth explored. The foundation type recommended by the geotechnical engineer for the hospital was deep foundations bearing on bedrock (rock sockets). The rock sockets would consist of 30-inch diameter concrete piers down to bedrock.

The soils at the staff quarters site primarily consist of a surface layer ranging between 2 and 12 feet of silty sand (SM) with low plasticity and varying amounts of gravel. The underlying subsurface soil encountered during field exploration consisted of a combination of silty gravel with sand (GM), gravel with silt and sand (GW-GM), gravel with silt and sand (GP-GM), clayey gravel with sand (GC), clay with sand and sandy clay with gravel (CL), clayey sand with gravel (SC), silty sand with gravel (SM), and sand with silt and gravel (SP-SM). These soils appear to be of volcanic origin and the relatively low densities are consistent with cinder deposits. Auger refusal was encountered at 6 of the boring locations ranging in depth between 4 and 24 feet below the existing surface elevation. A perched groundwater table was observed within 6 of the borings at depths ranging from 11 to 30 feet below the existing ground surface elevation. It is anticipated that groundwater will not be a factor in design or construction of the planned improvements unless utilities go beyond the depth of the perched groundwater level. The geotechnical engineer recommended two different types of foundations for the quarters site. The first, spread footings with specific subsurface soil treatment requirements and the second, post-tension slabs again with specific subsurface soil treatment requirements.

Domestic water supply and wastewater disposal needs have been identified and the WMAT’s Public Works Department has committed to providing the capacity for these services, provided IHS builds the required infrastructure. It is anticipated the WMAT’s surface water treatment facility capacity would need to be upgraded for the new WIH. A new filtration unit is proposed to be added to increase capacity at the plant by approximately 50%. Annual fire hydrant testing at the existing WIH site recorded deficient flows for the existing water system to meet the fire suppression demands of the new facility. To address this deficiency, costs of providing a new dedicated on-site water storage tank on a hill above the campus

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Executive Summary Page 4 along with properly sized water main is recommended to be included in the next budgetary estimate update. The existing WMAT’s wastewater treatment lagoons are reported to be at capacity and would also require upgrading. Estimated costs for these upgrades are $2.5 million.

At the Hon Dah quarters site, the WMAT’s water supply and distribution system is reported to be near maximum capacity. It is expected that an additional supply well and a water main extension to the new subdivision will be required. The waste water treatment lagoons that would serve the new Hon Dah quarters site is currently providing service to the Hon Dah Tribal Casino, campground and an existing Tribal residential subdivision. The existing lagoons are near maximum capacity and would require expansion to accommodate the additional 144 housing units. The estimated cost to upgrade the water system and the lagoons for the Hon Dah quarters expansion is approximately $1.3 million.

Preliminary electrical service requirements have been calculated and Navopache Electric Cooperative, the local electric utility, is already providing service to the existing Hospital site. A 3-phase power line crosses the southern portion of the Hospital site. At the Hon Dah quarters site, there is electrical power along the northern portion of the housing site. Navopache Electric Cooperative has confirmed that they will provide service to both sites with connection costs expected to be less than $100K.

There is no natural gas service to either site. Presently the WIH uses propane service from Ferrellgas. It is expected that propone service will be provided to the new WIH with only nominal fees to the project. In addition, ample supplies of propane and diesel fuel are available from local suppliers throughout the area for standby generation needs. Telephone and high-speed data communication services are available and will be provided by Frontier Communications.

Both sites have been evaluated for flooding potential, historic properties, environmental factors and physical characteristics including physical accessibility, size, topography and climate. A comprehensive environmental assessment of the proposed sites was conducted. The assessments concluded that no significant deleterious impacts on the quality of the natural, biological, socioeconomic, or cultural environments are expected to occur as a result of construction of either the new WIH or quarters.

All utility requirements have been assessed and existing utilities are either adequate to support the proposed facilities, or in the case of necessary infrastructure upgrades, their implementation can readily be incorporated as part of the project’s design and construction.

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Executive Summary Page 5

It is concluded that the proposed sites are suitable for the construction of the new WIH and the 144 quarters. However, the Phase II site evaluation herein has determined that the provision of required utilities and services will result in a budgetary increase of approximately $3.4 million to the current Facilities Budget Estimate.

The sites described herein have been fully evaluated and determined to be in compliance with all standards set forth in the Phase II SSER evaluation criteria.

Both sites are suitable choices for their planned objectives. The recommendation of the Phase II SSER signatories is that the Indian Health Service should approve final selection of both sites for design and construction of the new WIH and the 144 quarters.

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Basic Project Data Page 6

II. BASIC PROJECT DATA

A. IHS Area

The new WIH will be located in the Whiteriver Service Unit, which is within the service area of the Phoenix Area Indian Health Service.

B. Facility Name and Location

Whiteriver Indian Hospital 200 West Hospital Way Whiteriver, Arizona 85941 Navajo County, Arizona

C. Type of Health Care Facility

The proposed WIH will be an inpatient rural hospital predominantly serving the local White Mountain Apache Tribal Community, but will also serve the Native American patient population in the surrounding communities of Cibecue, Canyon Day, Carrizo, Cedar Creek, Forestdale, Hon-Dah, McNary, East Fork, and Seven Mile.

D. Project Type

The proposed WIH will be new construction with no usage of existing facilities.

E. Proposed Health Care Services

Space will be utilized to support the various health care services and programs including, but not restricted to, the following:

Ambulatory Services Family Practice Internal Medicine Pediatrics Women’s Clinic, OB/GYN Dental Optometry Podiatry Audiology Case Management Telemedicine

Emergency Department / EMS Emergency Department ED Detox

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Basic Project Data Page 7

Prisoner Transfer / Hold SANE Services Suicidal / Homicidal Ideation EMS Air Transportation CDU / Infusion / Observation

Surgical Specialty Services General Surgery Ophthalmology ENT Orthopedics Podiatry

Medical Specialty Services Cardiology Endocrinology Nephrology Pulmonology Rheumatology Chemotherapy Genetic Testing Pacemaker Clinic Sleep Study

Acute Care Inpatient Labor and Delivery Obstetrics Pediatric Medical Intensive Care Discharge Planning

Surgery Endoscopy Outpatient Surgery Inpatient Surgery C-Section

Ancillary Services Inpatient Pharmacy Out-Patient Pharmacy Coumadin Clinic Laboratory X-ray Ultrasound Mammography Fluoroscopy CT Scan MRI Physical Therapy Wound Care Occupational Therapy Speech Therapy Respiratory Therapy

Behavioral Health Psychiatry Adult Residential Intake Srv Social Service BH ED & IP Response Team

Preventative Care Public Health Nursing Public Health Nutrition

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Basic Project Data Page 8

Health Education Community Health Reps Wellness Center Environmental Health OEHE

Administrative Support Services Administration Human Resources Infection Control Staff Training Patient Advocacy QM/QI Services Business Office (RPMS) Health Information Management Public Information Support Information Technology Clinical Informatics PRC (Incl. Case Mgmt.)

Security

Facility Support Services Clinical Engineering Facility Management Dietary Medical Supply/Central Supply Property & Supply Housekeeping & Linen

Additional Services Alt. & Traditional Healing Body Holding (Morgue) Student Training John Hopkins Research Center Diabetes Management Healthy Heart VA Benefits Counselor Social Security Benefits Coordinator Hospice AZ Long Term Care Technicians Transportation Women, Infant & Children (WIC) Rocky Mt. Spotted Tick Fever

F. Health Care Facility Size

The new WIH is planned to be 400,000 ft2.

G. Inpatient Beds

The number of inpatient beds will be 24 (Medical / Surgical / ICU)

H. Projected Annual Outpatient Visists

It is estimated that the proposed WIH will see an increase of outpatient visits per year from 62,466 in 2016 to a projected 99,931 per year in 2025.

I. Projected Annual Dental Service Minutes

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Basic Project Data Page 9

It is estimated that the proposed WIH will see an increase of dental service minutes from 1,364,580 in 2016 to a projected 1,600,085 per year in 2025.

J. Staff

The Program Justification Document called for a total of 981 full time equivalent (FTE) positions for the WIH. In addition, there will be 47 Tribal Program employees working in the facility. Therefore, a total of 1,028 staff will be employed at this facility.

K. Staff Having Government/Tribal Vehicles

It is expected that 61 staff members at the WIH will have Government/Tribal vehicles assigned for their use and parked at the facility.

L. General Use Government/Tribal Vehicles

It is expected that a total of 10 Government/Tribal vehicles will be available for general usage by staff and parked at the facility.

M. Buses / Vans

It is expected that 1 passenger transport van will be permanently located at the facility.

N. Staff Quarters

There will be 144 staff quarters associated with this facility.

O. Special Components

There are no authorized special components associated with this facility.

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Land Area Requirements Page 10

III. LAND AREA REQUIREMENTS

A. Land Area Required for Proposed Health Care Facility

Health Care Facility = 400,000 ft2/(43,560ft2/acre) = 9.18 acres

B. Special Site Requirements

1. Heliport / heliport 2 acres

C. Land Area Required for Proposed Staff Quarters Assume 40% of the 144 quarters will be 3 bedroom units, 30% will be 2 bedroom units and 30% will be 1 bedroom units.

1. Total staff quarters required = 144

(a) Total units (144) x 40% (58) 3 bedroom units

(b) Total units (144) x 30% (43) 2 bedroom units

(c) Total units (144) x 30% (43) 1 bedroom units

2. Attached (duplexes or condominiums) vs. Detached Units (single family houses)

(a) Attached units

(1) All of the 1 and 2 bedroom units = (43 + 43) = 86

(2) 1/3 of 3 the bedroom units = (1/3) x 58 19

(3) Total attached = 86 + 19 = 105

(b) Detached units (2/3 of the 3 bedroom units) = (2/3) x 58 39

3. Housing Site Area

(a) (39) Detached Units x 0.333 = 12.99 acres

(b) (105) Attached units x 0.333 = 34.97 acres

(c) Subtotal of housing area = 12.99 + 34.97 = 47.96 acres

4. Housing Site Recreational Area (add 5% residential area)

(a) 47.96 x 0.05 = 2.40 acres

5. Total Housing Area Required 47.96 + 2.40 = 50.36 acres

D. Proposed Parking

1. FACILITY STAFF PARKING

(a) Staff parking spaces required for an inpatient facility with no carpooling and limited staff quarters within 0.5 mile of the health

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Land Area Requirements Page 11 care facility = (1,028) staff x 0.8 x 0.75 = 617 staff parking spaces

Sub-total Staff Parking = 617 staff parking spaces

2. VISITORS AND PATIENT PARKING

(a) Inpatient Beds (24) x 1 = 24 parking spaces

(b) Annual Outpatient Visits (99,931) x 0.002 200 parking spaces

(c) Annual Dental Minutes (1,600,085) x 0.00004 = 64 parking spaces

Sub-total Visitors and Patients Parking = 288 parking spaces

3. GOVERNMENT VEHICLES PARKING

(a) Staff assigned vehicles = 61

(b) General use vehicles = 10

Sub-total Government Vehicle Parking = 71 parking spaces

4. OTHER VEHICLES PARKING

(a) Passenger transport van = 1

Sub-total Van/Bus = 1 parking space

5. TOTAL PARKING SPACES = 977 parking spaces

6. TOTAL PARKING = (977 x 0.008685) = 8.49 acres

E. Total Land Area Required

1. Direct Use

(a) Health Care Facility 9.18 acres

(b) Special Site Requirements 2 acres

(c) Staff Quarters 50.36 acres

(d) Parking 8.49 acres

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Land Area Requirements Page 12

(e) Subtotal 70.03 acres

(f) Buffer 15% x 70.03 acres 10.51 acres

(g) Total Land Area Requirement 80.5 acres (to nearest tenth)

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Utilities Requirements Page 13

IV. UTILITIES REQUIREMENTS

A. Water Supply

Hospital

150,000 OPV(*)s ÷250 days x 30 gallons/visit = 18,000 GPD

1,028 staff x 30 GPD/staff = 30,840 GPD

24 beds x 150 GPD/bed = 3,600 GPD

Sub-total Hospital Water Supply Requirement = 52,440 GPD (*) The outpatient visits amount includes a 50% increase for persons accompanying patients.

Staff Quarters

144 staff quarters x 350 GPD/quarters = 50,400 GPD

Sub-total Quarters Water Supply Requirement = 50,400 GPD

Projected Water Supply Requirement = 102,840 GPD

B. Sewage Disposal

Hospital total projected water use x 80% 52,440 GPD x 0.80 = 41,952 GPD

Quarters total project water use x 80% 50,400 GPD x 0.80 = 40,320 GPD

Projected Sewage Disposal Requirement = 82,272 GPD

C. Electric

Hospital

400,000 ft2 x 32.98 kWh/(ft2/yr) (**) = 13,192,000 kWh/yr 400,000 ft2 x 0.0103122 kVA/ft2 = 4,125 kVA demand (**) Number differs from guideline calculations. It is based on historical electrical power records of actual electrical power usage at similar desert health center facilities recently

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Utilities Requirements Page 14 completed at Parker and Polacca, AZ. This information was also used as the basis of design for the Southwest Ambulatory Care Center at Gila River, AZ, the Ft. Yuma Health Care Center at Winterhaven, CA, and the Northeast Ambulatory Care Center at Salt River, AZ.

Staff Quarters

201,600 ft2 x 3.0658 kWh/(ft2/yr) (***) = 618,065 kWh/yr 201,600 ft2 x 9.29 x 10-4 kVA/ft2 = 187 kVA demand (***) Assumes the average square footage of each house is 1,400 ft2.

Projected kWh/yr Electrical Requirement = 13,810,065 kWh/yr Projected kVA/ft2 Electrical Requirement = 4,312 kVA/ft2

D. Fuel

Hospital

400,000 ft2 x 1.15 G/ft2/yr (propane) = 460,000 G/yr 400,000 ft2 x 9.816 x 10-4 G/ft2/hr (propane) = 393 G/hr

Staff Quarters

201,600 ft2 x 0.29 G/(ft2/yr) (propane) = 58,464 G/yr 201,600 ft2 x 2.45 x 10-4 G/(ft2/hr) propane = 49.4 G/hr

Projected Yearly Fuel Requirement (propane) = 518,464 G/yr Projected Hourly Fuel Requirement (propane) = 442 G/hr

E. Solid Waste

Solid waste collection will be required on a weekly basis.

F. Hazardous Waste Disposal

It is anticipated that medical waste will be collected on a weekly basis. Other hazardous waste will be collected on an as-required basis.

G. Telephone

High-speed digital data lines will be will be required for voice, data and telemedicine applications.

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Utilities Requirements Page 15

H. Telecommunications (Television)

Access to television programming (cable or satellite) is recommended for the facility to accommodate patients and visitors.

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Technical Evaluations Page 16

V. TECHNICAL EVALUATION

A Phase I SSER was completed in March 2017 and approved by the Phoenix Area Indian Health Service (PAIHS) that same month. The report evaluated and ranked 4 sites proposed by the WMAT through a tribal resolution. All 4 of these sites were later re-evaluated by the tribe and deemed unsuitable. A new tribal resolution was passed on October 2017 (10-2017-232) (see Tab 5 Tribal Resolution Relating to Proposed Sites) which rescinded the 4 original sites and proposed 3 new sites for consideration.

On November 8, 2017, representatives from the IHS were invited by WMAT officials to meet on-site and review the 3 new locations. A 6 member team, comprised of an appointed representative from the PAIHS Office, 2 representatives from the Whiteriver IHS Service Unit and 3 representatives from the WMAT, conducted a second Phase I Site Selection field visit for the proposed WIH Replacement Facility.

The second Phase I SSER was completed in November 2017 and approved by the PAIHS that same month. The report evaluated and ranked 3 sites offered by the WMAT through a tribal resolution. One of the sites was the existing WIH site and the other 2 were Canyon Day sites located south of the existing WIH located in Whiteriver, AZ. After the field inspections of the 3 sites and careful consideration of the known archeological conditions, biological conditions, existing utilities, and access to the site, the team arrived at a consensus that the site at the existing WIH was the most feasible for construction.

The site recommended in the Phase I SSER has been reviewed and the information provided in that report has been validated in this report. Accordingly, the information below, assumptions, and determinations regarding the selected site have been determined to be valid. This report confirms that the selected site is still available and provides appropriate documentation to determine that the site is suitable for the intended usage.

The WMAT has expressed no intentions to date of assuming ownership of the facility pursuant to Public Law 93-638 (Title I or Title V). Therefore, a land lease with the government will be established.

A. REVIEW OF BASIC SITE DATA AND SERVICE REQUIREMENTS

1. Land Area Size

It was determined in Section III (E.) that a minimum of 80.5 acres of land is required for the finished facility and quarters based on the prescribed calculation methodology. This amount is slightly more than the 75 acres that was estimated in the Phase I SSER study. Through two separate

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Technical Evaluations Page 17 resolutions the WMAT tribal council has made available the existing 64.6 acre hospital campus for construction of the new WIH and 100 acres for the 144 staff quarters site that is located southeast of the Hon Dah Resort and Casino. The additional land will allow for future expansion of the healthcare facilities or the housing quarters subdivision. In the past, additional land space was not set aside around proposed facilities and expansion was not possible due to the facility being land locked by future development around the site. Therefore, the 164.6 acres of land at two different sites is fully adequate for the construction of the WIH and 144 quarters, including all structures, roads, parking, utility infrastructure, water retention basins, and future expansion.

2. Location

The building site for the new WIH is located on the southern portion of the existing 64.6 acre hospital campus. The physical address of the site is 200 W. Hospital Drive, Whiteriver, AZ 85941. The project area is directly west of Arizona State Route 73 in the Gila-Salt River Baseline Meridian, Section 25 of Township 6 North, Range 22 East; Section 30 of Township 6 North, Range 23 East; and Section 31 of Township 6 North, Range 23 East, United States Geological Survey 7.5’ Alchesay Flat and Whiteriver in Navajo County, Arizona.

The proposed WIH site is 3 miles northeast of the town of Whiteriver and is within 22 miles of the next largest non-native town of Pinetop. While most of the care will be offered on-site, specialized and complex care may require a trip to the Phoenix Indian Medical Center, roughly 185 miles (one way) west of the proposed WIH.

The new 144 quarters will be constructed on a 100-acre parcel of land southeast of the Hon Dah Resort and Casino, adjacent to the intersection of Arizona State Route 73 and 260 in Navajo County, AZ, within the boundaries of the Fort Apache Indian Reservation. More specifically, the project will be located within Section 22 of Township 8 North, Range 23 East and Section 23 of Township 8 North, Range 23 East, Gila-Salt River Baseline Meridian, United States Geological Survey 7.5’ Quadrangle Indian Pine, AZ.

The Reservation covers portions of Apache, Gila, and Navajo Counties.

The Reservation is 75 miles long and 45 miles wide and encompasses more than 1.60 million acres.

Whiteriver Indian Hospital & Quarters Phase II Site Selection Evaluation Report Phoenix Area Indian Health Service July 2019

Technical Evaluations Page 18

3. Current Population

According to the 2010 U.S. Census, the WMAT has a population of over 13,398. The majority of the population lives in and around Whiteriver, while other tribal members reside in the communities of Cibecue, Carrizo, Cedar Creek, Forestdale, Hon-Dah, McNary, East Fork, and Seven Mile.

Whiteriver is the largest of these communities, serving as the hub for healthcare services for tribal members.

The WIH primarily serves the WMAT members, however it extends its on-site services to any member of a federally recognized Indian Tribe.

4. Economy

Federal and Tribal government and various Tribal enterprises are the primary employers on the Reservation. The operations include Whiteriver IHS Indian Hospital, the Bureau of Indian Affairs, White Mountain Apache Tribe, Hon Dah Casino, Hon Dah Hotel and Conference Center, Sunrise Ski Park Resort, Hawley Lake Rental Cabins, and Fort Apache Timber Company. Agriculture (irrigated farming) and the local school systems also provide employment opportunities. Private-sector employment is available in and around the Community. Despite these sources of local employment, unemployment remains relatively high. According to the Arizona Department of Health Services (ADHS) 2016 WMAT Statistical data (latest available), the unemployment rate of the WMAT was 40.5%, while the average for Arizona was 9.7%.

Within the Community, the poverty levels remain higher than the statewide average, with 45.8% of families falling below this threshold versus a statewide average of 18.2%. Based on the 2016 ADHS Statistical data, the median WMAT family income was $28,176 and for the state of Arizona it was $49,799.

5. Housing

Based on the 2010 decennial census for the Fort Apache Indian Reservation, there are 3,301 occupied housing units, 61% of which are owner-occupied.

There is a limited inventory of private housing available for rent or purchase within 30 miles of the WIH site. The housing is located primarily within the cities of Pinetop-Lakeside, Show Low, and McNary.

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6. Community Services

The Reservation offers a wide range of community facilities including three community centers, rodeo grounds, a fairground, an indoor swimming pool, a community wellness center, a cultural center, a library, three gymnasiums, a 3,200 seat activity center, and a public park.

The Whiteriver Unified School District and the Cibecue Community School offer public education. Additional educational institutions include the Theodore Roosevelt School and the John F. Kennedy School operated by the Indian Education Division of the Bureau of Indian Affairs. The East Fort Lutheran Mission, also located on the Reservation, operates an elementary school. Higher educational opportunities are available through the regional Northland Pioneer College, which has a facility in central Whiteriver.

The White Mountain Apache Police Department is a federally accredited public safety agency staffed by 27 officers, including 18 patrol officers. The White Mountain Apache Police Department’s Communications Center is the primary answering point for all non-emergency and 911 emergency calls made on the Fort Apache Indian Reservation. Additionally, it provides dispatch services to the White Mountain Apache Police, WMAT Fire and Rescue and the WMAT Emergency Medical Services. The Communications Center operates 24 hours a day, 7 days a week, and is staffed by 13 certified dispatchers.

There is a local branch office of the Wells Fargo Bank in Whiteriver, a Bashas Grocery Store, and a Burger King fast food franchise. A tribally managed motel with 31 rooms, a restaurant and conference room is also located in Whiteriver. Located approximately 45 miles from Whiteriver, is Sunrise Park Resort, the Tribally run ski area where there is a ski lodge with 96 rooms, a restaurant, bar, and conference room with seating for up to 200.

Near Sunrise Resort, is Hawley Lake where there is a lodge with 12 rooms, 49 individual rental cabins, and a Café serving breakfast and lunch. The newest hotel on the Reservation is the 125 room Hon Dah Hotel, Casino, RV Park and Conference Center. This facility has conference space for up to 700 people and provides for various functions. Grocery stores, gas stations, video stores, and some convenience stores, are available at various locations on the Reservation.

Within 30 miles of the proposed site, off-site amenities are typical of those

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7. Fire Protection

The White Mountain Apache Fire and Rescue Department consists of three Fire Stations located in Cibecue, Whiteriver, and Hon Dah. There are 33 career Fire Suppression personnel, one Fire Chief, one Assistant Fire Chief, three Deputy Fire Chiefs and one Administrative assistant. There are four platoons that rotate on an A, B, C, and D shift.

The closest existing fire station to the proposed WIH site is in Whiteriver, which is located approximately 3 miles to the southwest. The closest existing fire station to the proposed 144 staff quarters site is located approximately 3 miles to the east in the community of McNary. The White Mountain Apache Fire and Rescue Department responds to approximately 2,000 emergency calls per year, of which 84% are EMS related.

There are mutual aid agreements between the White Mountain Apache Fire and Rescue Department and the surrounding cities/towns of Pinetop, Lakeside, San Carlos, and Show Low in the event of a major fire. As per the requirements of the IHS A/E Design Guide (2016) this new facility will be protected throughout by an approved automatic sprinkler system in accordance with the latest adopted version of the National Fire Protection Association (NFPA) code.

8. Access

The WIH project site is adjacent to Arizona State Route 73 and is located approximately 3 miles northeast of the town of Whiteriver and is 22 miles southwest of the next largest non-native town of Pinetop. At the access road to the project site, there are turning lanes on the north and south side of the highway. A Traffic Impact Analysis Study prepared for the site recommended the installation of a traffic signal at the main hospital entrance and a new secondary entrance for the WIH in order to relieve future potential congestion.

The 144 quarters, will be located on a 100 acre parcel of land southeast of the Hon Dah Resort and Casino, adjacent to the intersection of Arizona State Routes 73 and 260. A Traffic Impact Analysis Study prepared for the site

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The Reservation is considered both rural and isolated, the predominant form of transportation is the private automobile. The Reservation is accessible from U.S. Highway 60. The combination of U.S. and Arizona State highways on the Reservation total about 130 miles. An additional 700 miles of local paved and gravel roads serve Reservation communities under the Bureau of Indian Affairs jurisdiction.

9. Transportation

No scheduled public transportation is available to either project site. Private automobiles are expected to be utilized as the primary means of access to the WIH and quarters sites.

Most forms of public transportation are readily available in the adjacent cities of Pinetop-Lakeside and Show Low, including local and interstate bus service and taxis. Regularly scheduled airline service from Show Low, located 30 miles northwest of Whiteriver also has an airstrip and is served by Boutique Air with daily commuter flights to Phoenix Sky Harbor International. Whiteriver has an all-weather paved airstrip that is available for charter flights, including medical evacuations flights.

10. Unique Considerations

The WIH site is encircled by a dense forest of Ponderosa Pine trees and is surrounded by mountain peaks. The staff quarters site is located within a dense forest of Ponderosa Pine trees and is adjacent to the Hon Dah Casino.

11. Climate

Climate is affected largely by altitude, but most of the Reservation has a four-season climate. The Whiteriver area is located at an elevation of 5,164 ft and has an annual rainfall of 20 inches. Winters are moderate in Whiteriver, but higher elevations receive heavy snowfall and much colder temperatures.

Average high temperatures in July are 90o F and 55o F in January. Average low temperatures are 55o F in July and 24o F in December.

12. Topography

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The Reservation is bounded to the north by the Mogollon Rim of the Colorado Plateau and the Sitegraves and Coconino National Forests, the San Carlos Apache Reservation on the south, the Apache National Forest on the east, and the Tonto National Forest on the west.

The Reservation has a wide range of topography. In general, the land surface slopes to the south and southwest and the relief is rather high, exceeding 8,700 feet. The area includes desert foothills on the west at an elevation of 2,700 feet in the Salt River Canyon to mountainous, forested northeastern portions of the Reservation where a high elevation of 11,409 feet on Mt. Baldy near the east boundary of the Reservation.

The hospital site is located in the northern portion of the town of Whiteriver.

The site has been previously graded and developed to construct the existing Whiteriver Indian Hospital, housing, parking lots, and various outbuildings.

The site is virtually flat, sloping 2% to the southwest, at elevation 5,440 feet above mean sea level.

The staff quarters site is located 22 miles to the north, at elevation 7,200 feet above mean sea level. The site slopes generally to the south and east, at approximately 4%, with slightly rolling terrain.

13. Visual

The site is located in a native undisturbed Ponderosa Pine Forest which shields it from the surrounding communities to give it an isolated feeling.

(See Environmental Assessment in Tab 11 for additional information).

14. Air Quality

No known air quality problems or restrictive regulation on air quality exist.

(See Environmental Assessment in Tab 11 for additional information).

15. Surface Water

Per the National Wetlands Inventory (NWI), the hospital site is bordered to the southwest by a 0.5-acre freshwater pond with an unconsolidated shore, and a stream classified as a riverine intermittent streambed, seasonally flooded. The stream flows northwest to southwest, and drains into the North Fork White River, which is located on the east side of SR 73. The stream is exhibiting a tendency to migrate towards the hospital site. Offsite flows

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Per the NWI and field investigation by the project biologist, there are no wetlands within a half-mile of the quarters site. (See Floodplain Assessment/Certification in Tab 7 and Environmental Assessment in Tab 11 for additional information.)

16. Flood Clearance

The North Fork White River flows 25 miles from the west slope of Mt Baldy, and merges with the East Fork White River to form the White River.

It flows south on the east side of SR 73, as close as 700 feet to the hospital site, and 3 miles east of the staff quarters site. Due to the approximately 160-foot deep gorge in which the river flows, the hospital site is not impacted by its floodwaters, which generally don’t rise over 25 feet.

Federal Emergency Management Agency (FEMA) maps the hospital site on Flood Insurance Rate Map (FIRM) 04017C5050E as Zone X, Area of Minimal Hazard (FEMA, 2008), and the quarters site on FIRM 04017C4975F as Zone D, Area of Undetermined Flood Hazard (FEMA, 2015). Neither site is located in a mapped floodplain. (See Floodplain Assessment/Certification in Tab 7).

17. Types of Soil

The soils within the hospital site consist primarily of low to medium plasticity clay (CL). Layers of clayey gravel with and without sand and cobbles (GC), sandy clay and clay with gravel (CL), gravel (GP), were also encountered during the field exploration. The underlying subsurface material consisted of well weathered very hard gray igneous bedrock (basalt) which caused auger refusal in 18 of the boring locations ranging in depth from 2 and 24 feet below the existing surface elevation.

The soils within the staff quarters site primarily consisted of a surface layer ranging between 2 and 12 feet deep and consisted of silty sand (SM) with low plasticity and varying amounts of gravel. The underlying subsurface soil encountered during the field exploration consisted of a combination of silty gravel with sand (GM), gravel with silt and sand (GW-GM), gravel with silt and sand (GP-GM), clayey gravel with sand (GC), clay with sand and sandy clay with gravel (CL), clayey sand with gravel (SC), silty sand with gravel (SM), and sand with silt and gravel (SP-SM). These soils appear

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Technical Evaluations Page 24 to be of volcanic origin and the relatively low densities are consistent with cinder deposits. Auger refusal was encountered at 6 of the boring locations ranging in depth between 4 and 24 feet below the existing surface elevation.

A perched groundwater table was observed within 6 of the borings at depths ranging from 11 to 30 feet below the existing ground surface elevation. (See Preliminary Geotechnical Evaluation Report in Tab 8).

18. Archaeological and Cultural Resources Clearance

A complete Class I records search was conducted for the 64.6-acre Area of Potential Effect (APE) of the hospital site and the 100-acre APE of the staff quarters site in September 2018. The records search included archival resources of previously conducted surveys, previously identified archaeological sites, historic properties, and other cultural resources within the one-mile research buffers around the APEs. AZSITE noted that they have minimal to no information for the general area. The Museum of Northern Arizona (MNA) identified no previously conducted surveys and recorded sites within the APEs and one-mile buffers. The Arizona State Historic Preservation Office (SHPO) has no records of previously recorded sites or surveys. Government Land Office survey maps and patents were also researched and no structures or features were identified within the APEs or the buffers (NorthWind, 2018d). The WMAT Cultural Resource Director indicated that no Traditional Cultural Properties are present at either site (Riley, 2018).

The WMAT has been approved by the National Park Service for a Tribal Historic Preservation Office, therefore, they will be the entity overseeing the Section 106 consultation process. The IHS found no historic properties and stated no further investigation is recommended. The Tribal Historic Preservation Officer concurred with this recommendation. If archaeological remains are encountered during construction, all on-site operations would be suspended pending further investigation by IHS and the WMAT (See Cultural Resources Survey in Tab 9).

19. Existing Water Supply System

Water at both sites is supplied and maintained by the White Mountain Apache Tribal Utility Authority (WMATUA). The WIH and the quarters water supply networks are separate systems, each with its own supply, storage, and distribution system.

The WIH is supplied with water from 13 wells in the Miner Flat area.

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Recorded flows for all of the 13 Miner Flat Wells running simultaneously is approximately 1,450 gpm, or 2 MGD however, there is concern regarding the long-term reliability of this source since production rates and water levels for each of the wells have been declining. Downstream of the WIH there is a conventional Surface Water Treatment Plant (SWTP) rated at 2 MGD. The SWTP is supplied with water from the north fork of the White River. A dam with river intake, raw water pump station, pre-sedimentation pond, and two Tonka Inc. conventional package treatment trains, provide water to the public water system. The building housing these treatment trains has space available for two additional treatment trains. Although rated by Tonka Inc.