Abstract: In-stream limestone sand addition (ILSA) has been employed as the final treatment for acid mine drainage discharges at Swamp Run in central West Virginia for six years. To determine the small-scale longitudinal variation in stream water and sediment chemistry and stream biota, we sampled one to three locations upstream of the ILSA site and six locations downstream. Addition of limestone sand significantly increased calcium and aluminum concentrations in sediment and increased the pH, calcium, and total suspended solids of the stream water. Increases in alkalinity were not significant. The number of benthic macroinvertebrate taxa was significantly reduced but there was no effect on periphyton biomass. Dissolved aluminum concentration in stream water was reduced, apparently by precipitation into the stream sediment.