The storage of coal combustion residuals (CCR) in aquatic surface impoundments has been a common practice across the United States for decades. Typically these aquatic surface impoundments are designed to allow the upper portion of the ash-basin water column to be removed and emptied into nearby freshwater or coastal systems. This method of coal-ash storage and disposal creates the potential for chronic point-source inputs of toxic metals into vital aquatic resources. The goal of this study was to investigate the potential ecological impacts of coal-ash associated metals on a freshwater ecosystem adjacent to a recently decommissioned coal-ash basin on Mountain Island Lake, NC. Ecological impacts were quantified through chemical analysis of water and sediments, and the use of the freshwater clam Corbicula fluminea as a bioindicator species. Clams were allocated into cages and deployed in situ at five sites near the ash basin for a one-month duration. Study sites included two locations within Mountain Island Lake’s coal ash effluent mixing zone, two locations further downstream, and one upstream reference site. After exposure, clam soft tissues were assessed for coal-ash associated metal bioaccumulation using Atomic Absorption Spectroscopy (AAS) and Direct Mercury Analysis (DMA), and clam health was assessed using a suite of sub-lethal cellular toxicity assays (lysosomal destabilization, lipid peroxidation, and micronucleus). Site water and sediments were collected from each study site and analyzed for common coal-ash associated metals. One-week laboratory exposures were also conducted using field collected water and sediments. The use of these integrative methods can provide important insights into the temporal and spatial scales of CCR associated toxicity while also serving to further validate C. fluminea as a suitable bioindicator species in freshwater systems.