Groundwater in the Eastern Salt Range of Pakistan is the primary source of drinking water for local communities but is increasingly threatened by combined geogenic enrichment and anthropogenic activities, particularly mining and agriculture. In mineralized semi-arid regions, distinguishing overlapping contamination sources and associated risks remains a key challenge. This study evaluates the spatial distribution of heavy metal(loid)s (HMs), identifies dominant contamination sources, and assesses ecological and human health risks in groundwater from the Chakwal District. A total of sixty groundwater samples were analyzed for Co, Cr, Cu, Mn, Ni, Zn, Pb, Fe, Cd, and As. Results indicate substantial spatial variability, with contamination hotspots concentrated near major coal mining areas. Chromium exhibited elevated concentrations (mean = 113 & micro;g/L), exceeding WHO guideline values at several locations, while Cu and Zn occurred at elevated levels relative to background conditions. Ecological risk assessment revealed extremely high risk in 42% of samples, primarily driven by Cd and As. Human health risk evaluation showed Hazard Index values exceeding unity (adults = 2.25; children = 3.15), indicating potential non-carcinogenic effects, while Total Carcinogenic Risk values surpassed acceptable thresholds (adults = 1.01 & times; 10(-)& sup3;; children = 2.82 & times; 10(-)(4)). Source apportionment indicates contributions from industrial emissions, geological weathering, agricultural runoff, and mixed sources. These findings highlight the combined influence of lithological controls and human activities on groundwater quality and underscore the need for targeted monitoring and risk-based groundwater management in mining-affected semi-arid regions.