The rapid proliferation of uranium production, combined with escalating anthropogenic activities, has led to pervasive contamination of drinking water sources by uranium, posing significant environmental and public health concerns. In addition, intensive riverbed mining practices have severely altered aquatic ecosystems, impairing water quality, habitat integrity, and biodiversity. Uranium further impairs risks by persisting in aquatic environments and resisting conventional water treatment technologies. This chapter critically reviews the occurrence, sources, pathways, and ecological impacts of uranium in drinking water systems. This study highlights the influence of riverbed mining on water clarity, sediment transport, and aquatic life and discusses microbial risks in graywater reuse systems through quantitative microbial risk assessment (QMRA) frameworks. Synthesizing recent findings, this chapter identifies pressing knowledge gaps, advocates for improved monitoring strategies, and outlines the need for integrative management approaches to safeguard aquatic ecosystems and human health.