Landfills for disposing of solid waste are designed, located, managed, and monitored facilities expected to comply with government regulations to prevent contamination of the surrounding environment. After the average life expectancy of a typical landfill (30 to 50 years), a large investment in the construction, operation, final closure, and 30-year monitoring of a new site is needed. In this case study, we provide a holistic explanation of the unexpected development of elevated temperature landfills (ETLFs), such as that in the city of Bristol (United States) on the border of the states of Virginia and Tennessee, including the initial role played by coal ash. Despite the increasing frequency of ETLF occurrence, there is limited knowledge available about their associated environmental problems. The study uses mixed (qualitative, quantitative, and mapping) methods to analyze (1) the levels of odoriferous reduced sulfur compounds, ammonia, and volatile organic compounds (VOCs) emitted, (2) the ratio of methane to carbon dioxide concentrations in five locations, which dropped from unity (normal landfill) to 0.565, (3) the location of gas well heads with gradients of elevated temperatures, and (4) the correlation of the filling rate (upward of ~12 m y−1) with depth for registered events depositing coal ash waste. The work identifies spatial patterns that support the conclusion that coal ash served as the initiator for an ETLF creation. The case of the city of Bristol constitutes an example of ETLFs with elevated temperatures above the regulatory United States Environmental Protection Agency (EPA) upper threshold (65 °C), having alongside low methane emissions, large production of leachate, land subsidence, and a large production of organic compounds. Such landfills suffer abnormal chemical reactions within the waste mass that reduce the life expectancy of the site. Residents in such communities suffer intolerable odors from fugitive emissions and poor air quality becomes prominent, affecting the well-being and economy of surrounding populations. Conclusive information available indicates that the Bristol landfill has been producing large amounts of leachate and hazardous gases under the high pressures and temperatures developed within the landfill. A lesson learned, which should be used to prevent this problem in the future, is that the early addition of coal ash into the landfill would have catalyzed the process of ETLF creation. The work considers the public health risks and socioeconomic problems of residents exposed to emissions from an ETLF and discusses the efforts needed to prevent further incidents in other locations.