Hi Sibbe:
There is a way to shape the terrain any way you want in any version of FS, whether FS-5 or MSFS-2024.
By default, however, the RWY infrastructure is geared towards AI Traffic which must have flat and level terrain.
To have an airport listed in the pick-list requires an Airport Reference Point (aka "ARP") which by default flattens RWYs.
One can hide a default RWY and drape default land class or custom photo-real aerial imagery textures over RWYs.
But, without custom terrain, RWYs will still be flat / level, and without an ARP, one may not have the airport in FS' pick-list.
P3D implemented a way to slope RWYs along their "long" axis, and ADE version 1.79x had a test of concept supporting that.
Now, in MSFS, we can once again use sloped RWYs, but we must "TerraForm" the terrain by various procedures.
IIRC, when Jon retired, he had not yet implemented sloped RWY support in ADE Alpha 20 version for MSFS.
The manual method Kronsky used is exemplary for a sloped airport RWY area using default MSFS SDK "TerraForming" tools.
https://www.fsdeveloper.com/forum/threads/how-to-get-runway-to-follow-terrain.449309/
It can take a bit of learning to do, however.
In Google Earth Desktop Edition now, 69NH evokes a Joni Mitchell song refrain: "
Paved Paradise ...Put Up A Parking Lot".
Please tell us what 'year' you want for your custom 69NH, as there is likely older GIS DEMs / DTMs that may help to do this.
And please post a screenshot here, of the current results you regard as unacceptable for the project area.
AFAIK, one makes a "TIN" from that elevation data, outputs a ESRI SHP file, imports to MSFS SDK DevMode Scenery Editor.
That can then be processed from a "primitive" Polygon to make a replacement airport terrain surface in the shape
you want.
PS: More cool stuff by Kronsky (these sceneries are excellent sloped RWY 'worked examples', and great fun for Bush Flying):
http://kronzky.info/fs/fs2020-idaho/
GaryGB