You can definitely have both. If you remove this mod then the lab floor chunk generation will also stop and normal terrain generation will resume (existing areas with lab floor will keep that lab floor). If on the other hand, you add it to existing world then it will add lab floor as you explore. Or you can leave it on and you're still in lab world, staring at the checkerboard.
Is this useful? It is up to you to add this or not as you see fit. It is a mod for a reason. I've used this on multiplayer worlds where we start on lab floors with a quantity of items in a bunch of chests and everyone builds on the lab floors. Then we later turn off the lab floors. Makes for skipping the first hour of grind while making it clear that the game has changed to wilderness. A friend of mine is using this with surface_reloaded to have a middle layer of uninterrupted space and wants the lab floor only on nauvis hence the update today (and likely a bug report of his own).
item 1 - defect. need to fix. no decorations are expected.
item 2-4 - you don't. you use whatever other means you have. Creative mod, cheats, clusterio, acts of god, world editor, etc.
Not all mods are intended to be opened and operated in isolation at face value with zero thought or effort. This is one of those mods. This mod definitely just puts you somewhere and leaves you alone.
I only really updated this mod to add nauvis only as the assumed surface. I might add a setting to turn this mod on/off during the game itself.