My settings are,
Initial points: 6 (Sometimes if I want a certain profession I will up it but only for a certain profession and not for raising stats or more beneficial traits)
Trait points: 12 (Feel it’s balanced enough to at least raise my stats to what I want and for at least for 3 bad and 3 good traits I feel like at the moment)
skill rust: capped (I usually toggle between this and skill rust since I enjoy both just depends on my mood, sometimes I do not feel like up-keeping some stats but sometimes I do do not mind)
Spring, 6 am: I sometimes choose winter to start in just depends on my mood. The 6 am is since it gets full daylight by around 7 I feel it gives me about an extra hour or two for that day to go around doing stuff before it starts to get dark and I feel I need to get to shelter to read something.
Season Length, 31 days: Just since most months have 30/31 days except for February I feel it just sets a more realistic mode for me.
Classic Zombies, False: I enjoy having to fight other supernatural type mobs.
Random NPC’s: Because they still cause problems with the game haha
Static Spawn, True: I just feel it’s more realistic and plus not having to worry about zombies spawning on top of you. Not sure if it does that anymore though.
Mutation By Radiation, True: Sometimes I turn this off but usually have it turned on since it makes me act more cautious before entering certain places by wearing the appropiate attire.
Distance Visibility, 20: Generally since it just opens more of the map at the start I figured no biggie since the world is huge and not like I have more of a chance of finding a cabin on the map at the start anyway or anything not seen often lol.
Mob Spawn Rate: 1.50 Normally 1.50 but sometimes I up it up to 3.0, have not tried higher yet. I feel there is not enough mobs in the standard 1.0
Item Spawn Rate: .50 to 1.0 sometimes. I find a ton of good items on 1.0 so I felt lowering it sometimes depending on my mood gives me more of a challenge
Delete World, Yes: I like perma-death and feel like I am cheating when I can just re-load a previous save even though I guess you could just make copies of the file but I feel if I die then that world should die.
Size of Cities, 4-7: I have tried it at cap and it was crazy fun but generally stick to default but 7 is normally the highest I go for now since it does make them decently pretty big.