It lies just southwest of Cornwall Kerosene & Tar.
- On the rock stack to the north of the main road is an abandoned camp with a lockbox containing Aged Pirate Rum and money. Near this is a rope hanging down the cliff. Near the top of the rock stack is a small rock ledge where the protagonist may sit facing west to watch a sunset.
- On the rock stack to the south near the top, there is a ledge where the protagonist may sit facing east.
- At the main road interchange to the northeast is a lockbox beneath an abandoned wagon containing chewing tobacco, Ginseng Elixir, jewelry, and Kentucky Bourbon.
- South of the main road, past the peak, is an Oil Derrick. At the bottom of the well beneath this is the Heartlands Oil Field Bone. On a crate within the nearby abandoned camp is Ginseng Elixir.
- Following the dried-up river from the Oil Derrick leads to the Heartlands Southern Gorge Bone. It is near the top of a hill to the southeast.
- Proceeding southeast of here and almost to the road is a tree containing hanging bottles. Ginseng Elixir can be found here.
- Twin Stack Peaks bears a close resemblance to Scotts Bluff in Nebraska.
- There is an ambush by either O'Driscoll Boys or unaffiliated criminals that triggers when the player passes through the location.