Irrigated agriculture has expanded greatly in the water-rich U.S. northern lake states during the past half century. Source water there is usually obtained from glacial aquifers strongly connected to surface waters, so irrigation has a potential to locally decrease base flows in streams and water levels in aquifers, lakes, and wetlands. During the nascent phase of the irrigation expansion, water availability was explored in works of some fame in the Wisconsin central sands by Weeks et al. (1965) on the Little Plover River and Weeks and Stangland (1971) on “headwater area” streams and lakes. Four decades later, and after irrigation has grown to a dominant landscape presence, we revisited irrigation effects on central sands hydrology. Irrigation effects have been substantial, on average decreasing base flows by a third or more in many stream headwaters and diminishing water levels by more than a meter in places. This explains why some surface waters have become flow and stage impaired, sometimes to the point of drying, with attendant losses of aquatic ecosystems. Irrigation exerts its effects by increasing evapotranspiration by an estimated 45 to 142 mm/year compared with pre-irrigated land cover. We conclude that irrigation water availability in the northern lake states and other regions with strong groundwater-surface water connections is tied to concerns for surface water health, requiring a focus on managing the upper few meters of aquifers on which surface waters depend rather than the depletability of an aquifer.