Named for the first territorial surveyor for Washington Territory James Tilton (surveyor),[6] it flows for about 29 miles (47 km), entirely within Lewis County.

[3] The Tilton River originates in the Cascade Range just north of Mount St. Helens and southwest of Mount Rainier.

It flows south and west, joining the Cowlitz River in Lake Mayfield, near Mossyrock.

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