Over the course of history, the development of human societies implied the exploitation of mineral resources which generated huge amounts of mining wastes leading to substantial environmental contamination by various metal(loid)s. This is especially the case of coal mine tailings which, subjected to weathering reactions, produce acid mine drainage (AMD), a recurring ecological issue related to current and past mining activities. In this study, we aimed to determine the origin, the fate and the ecotoxicity of metal(loid)s leached from a historical coal tailing heap to the Beuveroux river (Franche-Comté, France) using a combination of mineralogical, chemical and biological approaches. In the constitutive materials of the tailings, we identified galena, tetrahedrite and bournonite as metal-rich minerals and their weathering has led to massive contamination of the water and suspended particles of the river bordering the heap. The ecotoxicity of the AMD has been assessed using Chironomus riparius larvae encaged in the field during a one-month biomonitoring campaign. The larvae showed lethal and sub-lethal (growth and emergence inhibition and delay) impairments at the AMD tributary and near downstream stations. Metal bioaccumulation and subcellular fractionation in the larvae tissues revealed a strong bioavailability of, notably, As, Pb and Tl explaining the observed biological responses. Thus, more than 70 years after the end of mining operations, the coal tailings remain a chronic source of contamination and environmental risks in AMD effluent receiving waters.