The Pamet River has an extraordinary tidal change so anyone not fishing in a Quicksilver inflatable really has to launch and return during the upper portions of the tide. Fee for using the ramp, but if you arrive early and leave late you get a freebee. Two great ramps in Truro to access the river. One bordered by a dock. Plenty of parking. The Pamet River is a river in Truro, Massachusetts on Cape Cod. The river is primarily salt marsh, flows west nearly all the way across Cape Cod from its eastern beaches, and empties into Cape Cod Bay. It lies a few miles south of the Little Pamet River.