Hydrogeochemical analyses were carried out to identify geochemical processes occurring in the low-lying coastal aquifer of Ravenna, North Adriatic Sea (Italy). The area is characterized by a complex coexistence of several environments: coastal dunes, paleodunes, pine forests, freshwater wetlands, rivers, brackish lagoons, gravel pit lakes, reclaimed lands, agricultural fields and industrial areas. Water quality is of primary importance for the sustainability of these, areas and a full understanding of geochemical processing is fundamental for their management. A total of 104 water samples was collected from groundwater wells and surface water bodies, and analyzed for the major and trace elements (TEs). Field measurements of chemical-physical parameters were carried out by a multiparameter device XS PCD650; major elements were analyzed following the Italian National Environmental Agency standards (APAT-IRSA 2003), while TEs were analyzed by ICP-AES/ICP-MS. The major findings include: organic matter degradation in salinized and anoxic conditions; TEs concentrations related to water–sediment interactions, i.e., adsorption, ion exchange, redox reactions, mineral dissolution and precipitation; anthropogenic contamination from pesticides and fertilizers use; pollution from industrial district; TEs enrichments and depletion due to groundwater salinization and water management practices; comparison of TEs concentrations with respect to national and international thresholds. The findings can provide water managers and local authorities with a comprehensive framework of the coastal water hydrochemistry, allowing a better understanding of the effects of current management practices and the design of mitigation measures to reduce water resource deterioration in the studied coastal area.