By the time the Feb. 26, 1972, flood was over, 125 people had been killed. Another 1,100 were injured, and about 4,000 were left homeless.
A citizens' commission report called Buffalo Creek "a man-made disaster." A governor's task force concluded, "It was, in the truest sense, the most destructive flood in West Virginia history."
Today, hundreds of coal-waste dams still loom over Appalachian communities. Coalfield residents often worry it could all happen again.
Industry officials and most regulators say it won't. They point to tougher laws, stronger engineering standards and better construction practices put in place after the Buffalo Creek Disaster.
Other experts acknowledge serious improvements over the last four decades. Buffalo Creek spurred Congress to pass the federal Surface Mining Control and Reclamation Act. Lawmakers also added new dam-safety duties to the work of the federal Mine Safety and Health Administration when they rewrote coal-mine safety rules.
But coal-slurry impoundments remain a constant target for citizen concerns, and for the environmental community's growing efforts to crack down on the coal industry generally and mountaintop removal specifically. And some experts say there are reasons to be worried.
"We've come a long way since Buffalo Creek," said longtime mine inspector Jack Spadaro, who investigated the disaster for a special gubernatorial commission.
"We're better off than we were," said Spadaro, who now works as an engineering consultant for coalfield residents, workers and their lawyers. "But there are still very serious concerns."
Spadaro and other experts point to problems with coal-slurry leaking from impoundments into drinking water supplies, and to the potential for such leakage to weaken impoundment basins, prompting a disastrous "breakthrough" into nearby underground mines.
That's just what happened in October 2000 in Martin County, Ky. The floor fell out of Massey Energy's Big Branch Impoundment, and more than 300 million gallons of slurry -- 28 times larger than the Exxon Valdez oil spill -- poured into an adjacent underground mine. From there, the slurry flowed out into two local streams and into the Tug Fork of the Big Sandy River, along the West Virginia-Kentucky border.
Workers and residents escaped injury. But lawns were buried up to 7 feet deep, and all of the fish in two streams were killed. Drinking water supplies were fouled along more than 60 miles of the Big Sandy.