When the Chesapeake Bay Bridge connected Maryland's Eastern and Western shores in 1952, land speculators were among the first to cross it.

They bought swaths of Kent Island land that hugged the Chesapeake and the small creeks feeding into it. They divided the land for thousands of summer cottages as quickly as possible. In those days — before building permits and zoning ordinances, before the state critical area law and strong federal wetlands protection laws — they built homes as close to the water as they could. With no sewer service available, they installed basic septic systems.

By 1989, Queen Anne's County health officials had put a stop to the building frenzy in the southern Kent Island communities along Route 8, which abut the Chesapeake and creeks that feed into it. But it was too late. More than 1,500 homes had already been built in nine communities along the clogged artery that dead-ends at Eastern Bay. Many of them — particularly those in the communities of Kent Island Estates and Romancoke on the Bay — were on septic systems with a record of failure.

Since 1978, the county has planned to hook the communities up to Kent Island's sewage-treatment system. But in the early years, it didn't have the money, and in more recent decades many residents turned against the idea.

Connecting to the island's sewage system would reduce the nitrogen from 60 milligrams per liter on a failing septic system to about 3 milligrams per liter, according to health officials. It would get the county nearly halfway to the goals it set in its watershed implementation plan. It would be far better for human health, because bacteria in the septic fields can cause all sorts of digestive ailments as well as hepatitis. And it would give existing homeowners the right to add new bathrooms to their homes and otherwise improve their properties, which they currently have difficulty doing.

But it would also pave the way for about 900 now-vacant buildable lots in the community to be developed. That would mean more traffic on a highly congested island and more children in the crowded schools. And it would cost around $71 million, which could lead to major increases in the utility bills for existing homeowners: About $10,000 for each home to connect to the system, and potentially thousands of dollars more a year for service, depending on how many now-vacant lots shared in the costs.

"It's almost like a Sophie's Choice kind of thing," said Richard Hall, Maryland's Secretary of Planning. "It's a daunting task, financially, politically and logistically. It's something that everyone — the county government, the state government — wants to figure out. How do we start? We haven't answered that yet."

But for Queen Anne's County environmental health director, John Nickerson, the answer was clear a long time ago.

"From a health standpoint, it's crying out for public sewer," Nickerson said. "It is a public health issue, and public sewer is the only practical permitted solution."

The septic systems in the area routinely fail in the island's wet season, from February through April. The sewage then seeps into the groundwater, which children can contact during outside play. There have been several reported cases of giardia, an intestinal ailment that causes diarrhea, but Nickerson said he could not prove the cases stemmed from sewage in the yards. Fortunately, the drinking water is on a well system and isn't affected.

In some septic systems, Nickerson said, the drain field is not big enough. The area's water table is high, so the sewage doesn't have a place to run out. Replacing the septics with denitrifying systems won't help much, because often, the drain fields become submerged. Such was the case on a recent visit to the island after a high tide.

In the high-water-table season, the effluent from the septic systems sits in the ditches between people's homes, with a blue tinge to it. County Commissioner Phil Dumenil, who ran on a platform of extending sewage to the area, said the blue reminds him of the rainbow tinge left after water hits a patch of oil.

"There just flat out is a problem when you can see raw sewage in the ditches in the road between people's houses," he said. "You can't have that."

The homes platted before 1973 were built to accommodate one replacement system, and many of them are already on it. When that one fails, Nickerson said, there's no room to put a new one in.

Nickerson has been trying to persuade the county to put the communities on sewer for more than 30 years. His efforts increased in 2007. He met with officials at the Maryland Department of the Environment to seek state funding for the project. But because the communities are not in a growth area, which get priority, MDE officials said they couldn't help.

Nickerson and the former county health officer, Dr. C. Devadason, also asked MDE officials to order the county to hook the communities up to sewer, which the agency had already done for another development in the county that had problems.

"We believe that there is clear evidence of continuing septic failures and that a permanent solution is warranted that will not only alleviate public health concerns, but also minimize or eliminate environmental pollution as they relate to groundwater penetration and the health of the Chesapeake Bay. You will agree that the mission of local public health is to prevent disease rather than respond to outbreaks once they occur," Devadason wrote.

The state declined to enter into such an order. Maryland has a strong tradition of counties and towns keeping much of their own authority in development and growth decisions.

MDE spokesman Jay Apperson said the state can advise the county, but it is the county that must make the decision whether or not to pursue a sewage hookup.

"We are, of course, interested and hopeful that the longstanding problem of failing septic systems in southern Kent Island will be addressed," Apperson said.

Hall said his agency is supportive of Kent Island addressing the problem, which he said was unique to Kent Island. Other communities have failing septics, but none have so many in so confined a space so close to the Chesapeake. Yet Hall can't force the county to do anything. The Planning Department's role is largely advisory.

"They have not articulated a desire to really tackle this," Hall said. "They've had mixed feelings about it. There's not a totally cooked proposal to respond to."

The county has tackled the issue in fits and starts, with Nickerson continuing the push as Queen Anne's commissioners over the past two decades have swung from a pro-growth board to anti-growthers who do not wish for any more houses to be built on the already squeezed island, then back to a mix.

In 2010, the county hired an engineering firm to produce a detailed study. Their Southern Kent Island Sanitation Project report outlined six scenarios. Five involved hooking the area up to sewage treatment, with varying numbers of the vacant lots developed. One, the most expensive at about $80 million, looked into building several smaller treatment plants and not allowing any of the vacant lots to be served.

If the community hooks up to sewer and includes all properties, the vacant lot owners could help reduce the costs by paying a benefit-improvement charge. Eugene McGuire, a Vienna finance manager who owns a weekend home on the island as well as several unimproved lots, said the landowners' group is more than willing to do that. Some of them have died waiting for the right to develop their property, and it has been passed down from grandparents to grandchildren.

A resident of sprawling Northern Virginia, McGuire well understands Kent Island's fear of becoming a Glen Burnie-like suburb filled with big-box retailers. Indeed, voters resoundingly rejected two recent ballot initiatives that would have brought more growth and big-box stores to the county. But, he said, the system is needed to correct a public health problem, and the lot owners can help fund it.

"If this isn't smart growth, what is?" McGuire asked. "If people have to go somewhere, wouldn't it make sense to put them in communities that already exist?"

Some commissioners, like Bob Simmons, question the landowners' motives in taking up the public health cause. Simmons said he's conflicted about the sewer line, and would like to explore options such as nutrient trading to raise some cash and purchase development rights.

Some longtime residents, like former planning commission member Mary Kerr, acknowledge a problem with some people's septics, but say the public-sewer solution is out of whack with the problem's scope, and it will cause far more problems to the Chesapeake by encouraging more development and, as a result, more exhaust from cars.

She called the health issue a "red herring" and said no one had ever proved a health problem. As for those who were unable to develop their lots because the rules changed, she compares them to people who bought stock at the wrong time. They gambled, she said, and they are not owed a sewer line because of it.

Kerr has owned a home in Kent Island Estates since the 1950s. During that time, she's watched the community change from a sleepy summer cottage town to a place where no one dares run errands on a Saturday for fear they will not be able to return home because of Route 8 congestion.

"I cannot in my mind resolve the fact that they refuse to think of any other way of doing this," she said. "These are developer's interests, not citizens' interests."

In 2010, when the all-Republican board was elected, three commissioners supported the sewer line while two opposed it. But now Simmons stands alone: David Dunmyer, a home improvement contractor from Ruthsburg, has changed his mind. The commissioners also serve on the county's health board, and Dunmyer said he takes that role very seriously. He wants to limit growth, he said, but not at the expense of the public's health.

"We obviously have a health issue down there. We can't ignore it," Dunmyer said. "We've been ignoring it for a long time. I don't know how much longer we can avoid it."