Municipal wastewater (MWW) and mine drainage (MD) are common co-occurring sources of freshwater pollution in mining regions. The physicochemical interactions that occur after mixing MWW and MD in a waterway may improve downstream water quality of an impaired reach by reducing downstream concentrations of nutrients and metals (i.e., “co-attenuation”). A first-order stream (Bradley Run in central Pennsylvania), with coal MD and secondarily treated MWW entering the stream in the same location, was systematically monitored to determine in-stream water-quality dynamics. Monitored constituents included pH, nutrients (i.e., phosphorus and nitrogen), and metals (e.g., iron, aluminum, manganese). Mixing of the MWW, MD, and upstream water decreased concentrations of phosphate, aluminum, and iron by 94%, 91%, and 98%, respectively, relative to conservative mixtures at the 1400-m-downstream site. The pollutant co-attenuation resulted in water quality equivalent to that upstream of the pollutant sources and improved the phosphorus-based trophic status of the stream. Geochemical models indicate the primary mechanisms for P attenuation in the studied stream were precipitation as variscite (AlPO₄:2H₂O) or amorphous AlPO₄ plus adsorption to hydrous ferric oxide, despite a much greater abundance of hydrous aluminum oxide. The results presented in this study suggest that in-stream mixing of MD with untreated or secondarily treated MWW may be an important, overlooked factor affecting downstream transport of common pollutants in mining regions. Decreased metals loading and increased pH resulting from natural attenuation and remediation of MD could affect the potential for retention of phosphate by stream sediment and could lead to the release of nutrients from legacy accumulations, highlighting the potential need to address high-nutrient discharges (e.g., improved MWW treatment) in concert with MD remediation.