Water Resource Land Use Assessment Form
Assess how a site's land use may impact local water resources. Please answer all questions based on your site evaluation.
Site Name or Identifier
*
Location (City/Region)
*
Primary Land Use Type
*
Agricultural
Residential
Industrial/Commercial
Recreational/Open Space
Other
Approximate Distance to Nearest Water Body
*
On site
Within 100 meters
100–500 meters
Over 500 meters
Observed Water Management Practices
*
Stormwater retention/detention
Riparian buffer zones
Rain gardens/green infrastructure
No active management
Other
Potential Sources of Water Contamination (Select all that apply)
*
Fertilizers/pesticides
Livestock/animal waste
Industrial runoff
Septic systems
None observed
Other
Rate the Extent of Vegetative Cover on Site
*
None
1
2
3
4
Extensive
5
1 is None, 5 is Extensive
Observed Soil Erosion or Sedimentation Near Water
*
None observed
Minor
Moderate
Severe
Runoff Potential Assessment
*
Low (infiltrates easily)
Moderate
High (rapid surface flow)
Overall Water Resource Risk Assessment
*
1
2
3
4
5
Submit Assessment
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