15.C) General Wildlife Habitat 



AA is known or suspected (circle K or S) to receive (fill in blank) substantial (s), moderate (m), 



or little to no (I) use (see definitions for these terms) by the listed wildlife groups 



(see definitions for aquatic/semi-aquatic and non-aquatic wildlife) 



K S Aquatic/semi-aquatic birds Gist examples): 



K S Non-aquatic birds Gist examples): 



K S ^Aquatic/semi-aquatic mammals Gist examples): 



K S N on-aquatic mammals G>st examples): 



K S ^Aquatic/semi-aquatic reptiles G>st examples): 



K S ^Non-aquatic reptiles Gist examples): 



K S Amphibians Gist examples): 



K S Invertebrates Gist examples): 



i. Assessed wildlife use (circle points): 

 »3 s's or »5 m's + s's " 7 points 



1-2 s's or 2-4 m's = 3 points 



No s's and < 2 m's = 1 point 



Comments: 



ii. Habitat diversity from » 13 f circle twints) 

 High to exceptional rating > 3 points 

 Moderate rating = 2 points 



Low rating - 1 point 



Scort is G) X (ii) = 



I5.d) General Fish Habitat Gf AA does not contain or is not surficially connected to a fish-bearing stream or 

 standing water body [e.g., pond or lake], circle NA here and proceed to next function) 

 i. AA is known or suspected (circle K or S) to 

 support listed groups for portion of their 

 life cycle (circle points) 



Native fish 

 Introduced game fish 

 Introduced non-game fish 

 No fish 



5 points 

 3 points 

 2 points 

 1 point 



ii. Surface water in 

 AA is (circle points): 

 Permanent/perennial = 

 Seasonal/intermittent -= 

 Temporary/ephemeral = 



3 points 

 2 points 

 1 point 



Conunents: 



Scort is G) X Gi) ' 



15.e) Flood Attenuation and Storage (Applies only to wetlands subject to flooding via in-chaimel or overbank flow. 

 If wetlands in the AA are not flooded from in-channel or overbank flow, circle NA here and proceed to next fimction. 

 See IS.l) Dynamic Surface Water Storage for wetlands that flood, but not from in-channel or overbank flow.) 



i. Estimated acreage of jurisdictional 

 wetland in the AA that is subject 

 to periodic flooding (circle points): 

 Flooded wetlands k 10 acres 

 10 acres > Flooded wetlands > 2 acres ' 

 Flooded wetlands i 2 acres = 



7 points 

 5 points 

 I point 



ii. Estimated % of flooded wetland area 

 classified as forested(fo) , scrub-shrub (is), 

 or both (circle points) 

 > 75% fo/ss - 3 points 



25-75% fo/ss - 2 points 



< 25% fo/ss = 1 point 



iii. AA contains no outlet or restricted outlet 

 AA contains unrestricted outlet 



I point 

 points 



iv. Are residences, businesses, or other features which may be damaged by floods located within 0.5 miles 

 downstream of AA? If so, list here: 



Comments: 



Score is [G) x (ii)] + (iii) 



16.21 



6,7 



3,.» 



Rating 



High 



High 



High 



High 



Functianal 

 Points 



15.f) Sediment/Nutrient/Toxicant Retention and Removal 



Circle trrie m of false (F) for each of the following statements: 



i. T F AA receives direct discharge of managed water (municipal or road stormwater drainage, agricultural drainsge, 



industrial/municipal wastewater) or accumulation of sediment/excess nutrients evident (deposits on veseution, 



algal mats or other signs of eutrophication present) or immediate upstream land use has potential to delncr 



significant sediment/nutrient loads to AA. 



Evidence of flooding or ponding occurs in AA, 



T F 

 T F 

 T F 



AA contains restricted outlet or no outlet such that flow is slowed or detained. 

 Percent cover or emergent and/or dense woody vegetation in the AA exceeds 50%. 



(i) is true and at least two of (ii),(iii), or (iv) are true " High rating 



Rating is neither High or Low = Moderate rating 



(i) is false and at least two of Gi), (iii), or (iv) are false = Low rating 



Comments: 



(F2) 



