The present research was attempted to examine the human health risks due to nitrate contamination in the groundwater of Texvalley (Tiruppur region) of southern India. Groundwater samples (n = 40) were picked up from open wells (shallow aquifer) and tube wells (deep aquifer) during January 2020, and laboratory examination was conducted for various major physicochemical constituents. Nitrate concentration varied from 10 to 290 mg/l with a mean of 83.45 mg/l. About 58% (n = 23) of the wells exceeded the recommended limit (>45 mg/l) of World Health Organisation, which spread over an area of 335.16 km2. Among this, 45% of the samples (n = 18) represented shallow aquifers (depth < 15 m), and 13% of them (n = 5) represented deep aquifers (depth > 15 m). Synthetic fertilizers, cow dung and sheep manure, industrial discharge, septic tank leakage and municipal solid waste disposal are the major sources of nitrate pollution in this region. The USEPA health risk assessment model was applied in this study to assess hazard quotients (HQ) according to the NO3− exposure in various age groups of inhabitants through two different pathways such as drinking (HQoral) and skin contact (HQdermal). Eventually, total hazard index (THI) was obtained for all the groundwater samples for different age groups. According to THI, 87%, 78%, 66%, 60%, 56% and 48% of the samples contain health risks (THI >1) for infants, kids, children, teens, adults and aged people, respectively. The study finally recommended seven environmental friendly actions for the groundwater quality improvements and for the sustainable health management. Display omitted •Nearly 58% of the groundwater samples in Tiruppur region are affected by nitrate pollution.•Shallow aquifers are more polluted (45%) than deep aquifers (13%) due to anthropogenic inputs.•The major sources of nitrate are sewages, fertilizers and municipal solid wastes.•About 87% of the samples possess health risks for infants in Tiruppur region.