We analyzed 33 y of fish community data collected from a low-order, urban stream in central Illinois, USA, to determine the effects of municipal wastewater management projects and urbanization on fish communities. From 1985 to 2017, species richness, number of pollution-intolerant species, and alternative index of biotic integrity significantly increased at sites across this system. Species diversity likewise increased, but was mostly significant only at sites downstream of the effluent outflow. Ceasing the chlorination of wastewater in 1990 resulted in significant increases in fish community metrics both upstream and downstream of effluent outflow, although effects varied from site to site. Completing a combined sewer overflow abatement project in 2008 resulted in some significant increases in species richness, diversity, and number of pollution-intolerant species at sites downstream of effluent outflow. From 2001 to 2016, the change in the number of pollution-intolerant species correlated inversely with the increased percentage of impervious cover in the study system. There was no significant correlation of other metrics with the change in percent impervious surfaces. These results suggest that urbanization at upstream sites limited to some extent the benefits of water management interventions that improved fish community metrics at downstream sites.